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NORTH CAROLINA
2011 STATE MEDICAL FACILITIES PLAN
Effective January 1, 2011
Prepared by the
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Medical Facilities Planning Section
Under the direction of the
North Carolina State Health Coordinating Council
For information contact the
North Carolina Division of Health Service Regulation
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
http://www.ncdhhs.gov/dhsr/ncsmfp/index.html
(919) 855 - 3865 Telephone Number
(919) 715 - 4413 FAX Number
The North Carolina Department of Health and Human Services does not
discriminate on the basis of race, color, national origin, sex, religion, age
or disability in employment or the provision of services.
TABLE OF CONTENTS
Background
Chapter 1 Overview of the North Carolina 2011 State Medical Facilities Plan 1
Chapter 2 Amendments and Revisions 9
Chapter 3 Certificate of Need Review Categories and Schedule 19
Chapter 4 Statement of Policies: 23
Acute Care Hospitals 23
Nursing Care Facilities 26
Adult Care Homes 32
Home Health Services 34
End-Stage Renal Disease Dialysis Services 34
Mental Health, Developmental Disabilities, and 35
Substance Abuse (General)
Psychiatric Inpatient Services 35
Intermediate Care Facilities for the Mentally Retarded 35
All Health Services 36
Acute Care Facilities and Services
Chapter 5 Acute Care Hospital Beds 43
Chapter 6 Operating Rooms 63
Chapter 7 Other Acute Care Services 99
Open Heart Surgery Services and 99
Heart-Lung Bypass Machines
Burn Intensive Care Services 104
Transplantation Services 106
Chapter 8 Inpatient Rehabilitation Services 111
Technology and Equipment
Chapter 9 Technology 117
Lithotripsy 118
Gamma Knife 126
Linear Accelerators 127
Positron Emission Tomography Scanner 141
Magnetic Resonance Imaging 147
Cardiac Catheterization Equipment 183
Long-Term Care Facilities and Services
Chapter 10 Nursing Care Facilities 199
Chapter 11 Adult Care Homes 219
Chapter 12 Home Health Services 247
Chapter 13 Hospice Services 303
Chapter 14 End-Stage Renal Disease Dialysis Facilities 347
Chapter 15 Psychiatric Inpatient Services 355
Chapter 16 Substance Abuse Inpatient And Residential Services 367
(Chemical Dependency Treatment Beds)
Chapter 17 Intermediate Care Facilities for the Mentally Retarded 377
Appendices
Appendix A: North Carolina Counties by Health Service Areas 391
Appendix B: Partial Listing of Health Planning Acronyms 393
Appendix C: List of Contiguous Counties 395
Appendix D: North Carolina Certificate of Need Statute 399
Appendix E: Regulation of Detoxification Services Provided in 421
Hospitals Licensed under Article 5, Chapter 131E,
of the General Statutes
DISCLAIMER
The North Carolina 2011 State Medical Facilities Plan is subject to revision throughout the year.
Notices containing updates and changes will be posted on the North Carolina Division of Health
Service Regulation web page at http://www.ncdhhs.gov/dhsr/ncsmfp/index.html as they are
approved. Check our web site periodically for updates.
Chapter 1:
Overview of the 2011 State Medical Facilities Plan
CHAPTER 1
OVERVIEW OF THE NORTH CAROLINA 2011 STATE MEDICAL FACILITIES
PLAN
Purpose
The North Carolina 2011 State Medical Facilities Plan (“Plan”) was developed by the
North Carolina Department of Health and Human Services, Division of Health Service
Regulation, under the direction of the North Carolina State Health Coordinating Council,
(SHCC) pursuant to G.S. §131E-177. The major objective of the Plan is to provide individuals,
institutions, state and local government agencies, and community leadership with policies and
projections of need to guide local planning for specific health care facilities and services.
Projections of need are provided for the following types of facilities and services:
 acute care hospitals
 operating rooms
 inpatient rehabilitation facilities
 technology services
 nursing care facilities
 adult care facilities
 Medicare-certified home health agencies
 end-stage renal disease dialysis facilities
 hospice home care and hospice inpatient beds
 psychiatric hospital units and specialty hospitals
 substance abuse hospital units, specialty hospitals,
and residential facilities
 intermediate care facilities for people with mental retardation
Chapters dealing with specific facility/service categories contain summaries of the supply
and the utilization of each type of facility or service, a description of changes in the projection
method and policies from the previous planning year, a description of the projection method, and
other data relevant to the projections of need.
The projections of need for the various facilities and services are used in conjunction with
other statutes and rules in reviewing certificate of need applications for establishment, expansion,
or conversion of health care facilities and services. All parties interested in health care facility
and health services planning should consider this Plan a key resource.
Basic Principles Governing the Development of this Plan
1. Safety and Quality Basic Principle
The State of North Carolina recognizes the importance of systematic and ongoing
improvement in the quality of health services. Citizens of North Carolina rightfully expect
health services to be safe and efficient. To warrant public trust in the regulation of health
services, monitoring of safety and quality using established and independently verifiable metrics
will be an integral part of the formulation and application of the North Carolina State Medical
Facilities Plan.
Scientific quantification of quality and safety is rapidly evolving. Emerging measures of
quality address both favorable clinical outcomes and patient satisfaction, while safety measures
focus on the elimination of practices that contribute to avoidable injury or death and the adoption
of practices that promote and ensure safety. The SHCC recognizes that while safety, clinical
outcomes, and satisfaction may be conceptually separable, they are often interconnected in
practice. The North Carolina State Medical Facilities Plan should maximize all three elements.
Where practicalities require balancing of these elements, priority should be given to safety,
followed by clinical outcomes, followed by satisfaction.
The appropriate measures for quality and safety should be specific to the type of facility
or service regulated. Clinical outcome and safety measures should be evidence-based and
objective. Patient satisfaction measures should be quantifiable. In all cases, metrics should be
standardized and widely reported and preference should be given to those metrics reported on a
national level. The SHCC recognizes that metrics meeting these criteria are currently better
established for some services than for others. Furthermore, experience and research as well as
regulation at the federal level will continue to identify new measures that may be incorporated
into the standards applicable to quality and safety. As experience with the application of quality
and safety metrics grows, the SHCC should regularly review policies and need methodologies
and revise them as needed to address any persistent and significant deficiencies of safety and
quality in a particular service area.
2. Access Basic Principle
Equitable access to timely, clinically appropriate and high quality health care for all the
people of North Carolina is a foundational principle for the formulation and application of the
North Carolina State Medical Facilities Plan. Barriers to access include, but are not limited to:
geography, low income, limited or no insurance coverage, disability, age, race, ethnicity, culture,
language, education and health literacy. Individuals whose access to needed health services is
impeded by any of these barriers are medically underserved. The formulation and
implementation of the North Carolina State Medical Facilities Plan seeks to reduce all of these
types of barriers to timely and appropriate access. The first priority is to ameliorate economic
barriers and the second priority is to mitigate time and distance barriers.
The impact of economic barriers is twofold. First, individuals without insurance, with
insufficient insurance, or without sufficient funds to purchase their own health care will often
require public funding to support access to regulated services. Second, the preferential selection
by providers of well funded patients may undermine the advantages that can accrue to the public
from market competition in health care. A competitive marketplace should favor providers that
deliver the highest quality and best value care, but only in the circumstance that all competitors
deliver like services to similar populations.
The SHCC assigns the highest priority to a methodology that favors providers delivering
services to a patient population representative of all payer types in need of those services in the
service area. Comparisons of value and quality are most likely to be valid when services are
provided to like populations. Incentives for quality and process improvement, resource
maximization, and innovation are most effective when providers deliver services to a similar and
representative mixture of patients.
Access barriers of time and distance are especially critical to rural areas and small
communities. However, urban populations can experience similar access barriers. The SHCC
recognizes that some essential, but unprofitable, medical services may require support by
revenues gained from profitable services or other sources. The SHCC also recognizes a trend to
the delivery of some services in more accessible, less complex, and less costly settings.
Whenever verifiable data for outcome, satisfaction, safety, and costs for the delivery of such
services to representative patient populations justify, the SHCC will balance the advantages of
such ambulatory facilities with the needs for financial support of medically necessary but
unprofitable care.
The needs of rural and small communities that are distant from comprehensive urban
medical facilities merit special consideration. In rural and small communities selective
competition that disproportionately captures profitable services may threaten the viability of sole
providers of comprehensive care and emergency services. For this reason methodologies that
balance value, quality and access in urban and rural areas may differ quantitatively. The SHCC
planning process will promote access to an appropriate spectrum of health services at a local
level, whenever feasible under prevailing quality and value standards.
3. Value Basic Principle
The SHCC defines health care value as maximum health care benefit per dollar
expended. Disparity between demand growth and funding constraints for health care services
increases the need for affordability and value in health services. Maximizing the health benefit
for the entire population of North Carolina that is achieved by expenditures for services regulated
by the State Medical Facilities Plan will be a key principle in the formulation and
implementation of SHCC recommendations for the State Medical Facilities Plan.
Measurement of the cost component of the value equation is often easier than
measurement of benefit. Cost per unit of service is an appropriate metric when comparing
providers of like services for like populations. The cost basis for some providers may be inflated
by disproportionate care to indigent and underfunded patients. In such cases the SHCC
encourages the adjustment of cost measures to reflect such disparity, but only to the extent such
expenditures can be measured according to an established, state-wide standard that is uniformly
reported and verifiable. Measurement of benefit is more challenging. Standardized safety and
quality measures, when available, can be important factors in achieving improved value in the
provision of health services. Prevention, early detection and early intervention are important
means for increasing the total population benefit for health expenditures. Development of new
technology has the potential to add value by improving outcome and enhancing early detection.
Capital costs of such new technology may be greater but justified by the added population
benefit. At the same time overutilization of more costly and/or highly specialized, low-volume
services without evidence-based medical indications may contribute to escalating health costs
without commensurate population-based health benefit. The SHCC favors methodologies which
encourage technological advances for proven and affordable benefit and appropriate utilization
for evidence-based indications when available. The SHCC also recognizes the importance of
primary care and health education in promoting affordable health care and best utilization of
scarce and expensive health resources. Unfortunately technologically sophisticated and costly
services that benefit small numbers of patients may be more readily pursued than simple and less
costly detection and prevention measures that benefit the broader population. In the pursuit of
maximum population-based health care value, the SHCC recognizes the potential adverse impact
for growth of regulated services to supplant services of broad benefit to the larger population.
Long-term enhancement of health care value will result from a state medical facilities
plan that promotes a balance of competition and collaboration and encourages innovation in
health care delivery. The SHCC encourages the development of value-driven health care by
promoting collaborative efforts to create common resources such as shared health databases,
purchasing cooperatives, and shared information management, and by promoting coordinated
services that reduce duplicative and conflicting care. The SHCC also recognizes the importance
of balanced competition and market advantage in order to encourage innovation, in so far as
those innovations improve safety, quality, access, and value in health care delivery.
The State Health Planning Process
Throughout the development of the North Carolina State Medical Facilities Plan there are
opportunities for public review and comment. Sections of the Plan, including the policies and
methods for projecting need, are developed with the assistance of committees of the North
Carolina State Health Coordinating Council (Table 1A). The committees submit their
recommendations to the Council for approval. A Proposed Plan is assembled and made available
to the public. Public hearings on the Proposed Plan are held throughout the State during the
summer. Comments and petitions received during this period are considered by the Council and,
upon incorporation of all changes approved by the Council, a final draft of the Plan is presented
to the Governor for review and approval. With the Governor’s approval, the State Medical
Facilities Plan becomes the official document for health facility and health service planning in
North Carolina for the specified calendar year.
Other Publications
Information concerning publications or the availability of other data related to the health
planning process may be obtained by contacting the North Carolina Division of Health Service
Regulation, Medical Facilities Planning Section.
North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
Telephone Number: (919) 855-3865
FAX Number: (919) 715-4413
NOTE
Determinations of need for services and facilities in this Plan do not imply an intent on the
part of the North Carolina Department of Health and Human Services, Division of Medical
Assistance to participate in the reimbursement of the cost of care of patients using services
and facilities developed in response to this need.
Table 1A: North Carolina State Health Coordinating Council Members,
Committee Membership, and Staff
Members: Representing: From:
William Wainwright, Chairman N.C. House of Representatives Havelock
Donald Beaver Health Care Facilities Association Hickory
Bill Bedsole At-Large Washington
Greg Beier At-Large Winston-Salem
Don Bradley, MD Health Insurance Industry Durham
Richard Bruch, MD Medical Society Durham
Dennis Clements, III, MD Academic Medical Centers Durham
Lawrence Cutchin, MD At-Large Tarboro
Johnnie Farmer County Commissioners Association Aulander
Senator Anthony Foriest N.C. Senate Graham
Sandra Greene, DrPH At-Large Chapel Hill
Ted Griffin Business and Industry Durham
Harold Hart Business and Industry Siler City
Laurence Hinsdale At-Large Concord
Daniel Hoffmann Veterans Administration Durham
John Holt, Jr., MD At-Large Raleigh
Eric Janis, MD At-Large Smithfield
Brenda Latham-Sadler, MD At-Large Winston-Salem
Leslie Marshall, MD At-Large Raleigh
Frances Mauney At-Large Durham
William McMillan, Jr., MD Area Health Education Centers Wilmington
Zach Miller Long-Term Care Facilities Association Wilmington
Jerry Parks Association of Local Health Directors Edenton
Prashant Patel, MD At-Large Cary
Thomas Pulliam, MD At-Large Winston-Salem
Pam Tidwell Home Care Association Asheville
Christopher Ullrich, MD At-Large Charlotte
Zane Walsh, MD At-Large Fayetteville
John Young Hospital Association Kings Mountain
Committees and Staff Members
Acute Care Services Committee
Planning for acute care beds, operating rooms, open heart surgery services, heart-lung
bypass machines, burn intensive care services, transplantation services [bone marrow transplants
and solid organ transplants], and inpatient rehabilitation services:
Sandra Greene, DrPH, (Chair); Greg Beier, (Vice Chair); Bill Bedsole; Lawrence Cutchin,
MD; Brenda Latham-Sadler, MD; Leslie Marshall, MD; Zane Walsh, MD; John Young
Staffed by: Dr. Carol Potter
Long-Term and Behavioral Health Committee
Planning for nursing care facilities, adult care homes, home health services, hospice
services, end-stage renal disease dialysis facilities, psychiatric inpatient facilities, substance
abuse inpatient and residential services (chemical dependency treatment beds), and intermediate
care facilities for the mentally retarded:
Thomas Pulliam, MD, (Chair); Jerry Parks, (Vice Chair); Donald Beaver; Johnnie Farmer;
Senator Anthony Foriest; Ted Griffin; Zach Miller; Pam Tidwell
Staffed by: Patrick Baker
Technology and Equipment Committee
Planning for lithotripsy, gamma knife, linear accelerators, positron emission tomography
scanners, magnetic resonance imaging scanners, and cardiac catheterization/angioplasty
equipment:
Christopher Ullrich, MD, (Chair); William McMillan, Jr., MD, (Vice Chair); Richard Bruch,
MD; Dennis Clements III, MD; Harold Hart; Laurence Hinsdale; John Holt, MD; Eric Janis,
MD
Staffed by: Dr. Carol Potter
Quality, Access and Value Committee
Quality, Access and Value Committee is charged with: promoting high quality health
care services as measured by outcomes and satisfaction, equitable access to health care services
for all North Carolina’s people, and high value practices that will maximize the health care
benefit gained for resources expended:
Don Bradley, MD, (Chair); Frances Mauney, (Vice Chair); Greg Beier; Daniel Hoffmann;
William McMillan, Jr.; Jerry Parks; Prashant Patel, MD
Staffed by: Patrick Baker
Medical Facilities Planning Section Staff
Elizabeth K. Brown, Chief
Gene DePorter, Assistant Chief, Planner
Patrick Baker, Planner
Carol G. Potter, Planner
Erin Glendening, Technology Support Analyst
Kelli Fisk, Administrative Assistant
Division of Health Service Regulation
Drexdal Pratt, Director
Chapter 2:
Amendments and Revisions
CHAPTER 2
AMENDMENTS AND REVISIONS TO THE STATE MEDICAL FACILITIES PLAN
Amendment of Approved Plans
After the North Carolina State Medical Facilities Plan has been signed by the Governor,
it will be amended only as necessary to correct errors or to respond to statutory changes,
amounts of legislative appropriations or judicial decisions. The North Carolina State Health
Coordinating Council will conduct a public hearing on proposed amendments and will
recommend changes it deems appropriate for the Governor's approval.
NOTE: Need determinations as shown in this document may be increased or decreased during
the year pursuant to Policy GEN-2 (See Chapter 4).
Petitions to Revise the Next State Medical Facilities Plan
Anyone who finds that the North Carolina State Medical Facilities Plan policies or
methodologies, or the results of their application, are inappropriate may petition for changes or
revisions. Such petitions are of two general types: those requesting changes in basic policies and
methodologies, and those requesting adjustments to the need projections.
Petitions for Changes in Basic Policies and Methodologies
People who wish to recommend changes that may have a statewide effect are asked to
contact the Medical Facilities Planning Section staff as early in the year as possible, and to
submit petitions no later than March 2, 2011. Changes with the potential for a statewide effect
are the addition, deletion, and revision of policies or projection methodologies. These types of
changes will need to be considered in the first four months of the calendar year as the "Proposed
North Carolina State Medical Facilities Plan" (explained below) is being developed.
Instructions for Writing Petitions for Changes in Basic Policies and Methodologies
At a minimum, each written petition requesting a change in basic policies and
methodologies used in the North Carolina State Medical Failities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. Statement of the requested change, citing the policy or planning
methodology in the North Carolina State Medical Facilities Plan for which
the change is proposed.
3. Reasons for the proposed change to include:
a. A statement of the adverse effects on the providers or consumers of
health services that are likely to ensue if the change is not made, and
b. A statement of alternatives to the proposed change that were
considered and found not feasible.
4. Evidence that the proposed change would not result in unnecessary
duplication of health resources in the area.
5. Evidence that the requested change is consistent with the three Basic
Principles governing the development of the North Carolina State Medical
Facilities Plan: Safety and Quality, Access, and Value.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the North Carolina Division of Health Service Regulation’s Medical
Facilities Planning Section by 5:00 p.m. on March 2, 2011. Petitions must be submitted by e-mail,
fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
701 Barbour Drive
Raleigh, North Carolina 27603
Response to Petitions for Changes in Basic Policies and Methodologies
The process for response to such petitions is as follows:
1. Staff, in reviewing the proposed change, may request additional
information and opinions from the petitioner or any other
personororganization(s) who may be affected by the proposed change.
2. The petition and other information will be made available to the members
of the appropriate committee of the North Carolina State Health
Coordinating Council.
3. The petition will be considered by the appropriate committee of the North
Carolina State Health Coordinating Council and the committee will make
recommendations to the North Carolina State Health Coordinating Council
regarding disposition of the petition.
4. The North Carolina State Health Coordinating Council will consider the
committee’s recommendations and make decisions regarding whether or
not to incorporate the changes into the final North Carolina State Medical
Facilities Plan.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for changes in basic policies and
methodologies in the North Carolina State Medical Facilities Plan will be made no later than the
final Council meeting of the calender year.
Petitions for Adjustments to Need Determinations
A Proposed North Carolina State Medical Facilities Plan is adopted annually by the
North Carolina State Health Coordinating Council, and is made available for review by
interested parties during an annual "Public Review and Comment Period." During this period,
regional public hearings are held to receive oral/written comments and written petitions. The
Public Review and Comment Period for consideration of each Proposed North Carolina State
Medical Facilities Plan is determined annually and dates are available from the Medical
Facilities Planning Section and published in the North Carolina State Medical Facilities Plan,
People who believe that unique or special attributes of a particular geographic area or
institution give rise to resource requirements that differ from those provided by application of the
standard planning procedures and policies may submit a written petition requesting an
adjustment be made to the need determination given in the Proposed North Carolina State
Medical Facilities Plan. These petitions should be delivered to the Medical Facilities Planning
Section as early in the Public Review and Comment Period as possible, but no later than the last
day of this period. Requirements for petitions to change need determinations in the Proposed
North Carolina State Medical Facilities Plan are given below.
Instructions for Writing Petitions for Adjustments to Need Determinations
At a minimum, each written petition requesting an adjustment to a need determination in
the Proposed State Medical Facilities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. A statement of the requested adjustment, citing the provision or need
determination in the Proposed State Medical Facilities Plan for which the
adjustment is proposed.
3. Reasons for the proposed adjustment, including:
a. Statement of the adverse effects on the population of the
affected area that are likely to ensue if the adjustment is
not made, and
b. A statement of alternatives to the proposed adjustment
that were considered and found not feasible.
4. Evidence that health service development permitted by the proposed
adjustment would not result in unnecessary duplication of health
resources in the area.
5. Evidence that the requested adjustment is consistent with the three Basic
Principles governing the development of the N.C State Medical Facilities
Plan: Safety and Quality, Access and Value.
Petitioners should use the same service area definitions as provided in the program
chapters of the Proposed North Carolina State Medical Facilities Plan.
Petitioners should also be aware that the Medical Facilities Planning staff, in reviewing
the proposed adjustment, may request additional information and opinions from the petitioner or
any other person and organization(s) who may be affected by the proposed adjustment.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the Medical Facilities Planning Section by 5:00 p.m. on August 1, 2011.
Petitions must be submitted by e-mail, fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
701 Barbour Drive
Raleigh, North Carolina 27603
Response to Petitions for Adjustments to Need Determinations
The process for response to these petitions by the North Carolina Division of Health
Service Regulation and the North Carolina State Health Coordinating Council is as follows:
1. Preparation of an agency report. Staff may request additional information
from the petitioner.
2. Consideration of the petition and the agency report by the appropriate
committee of the North Carolina State Health Coordinating Council.
3. Committee submits its recommendations to the North Carolina State
Health Coordinating Council regarding disposition of the petition.
4. Consideration of the committee recommendations by the North
Carolina State Health Coordinating Council and decisions regarding
whether or not to incorporate the recommended adjustments in the final
North Carolina State Medical Facilities Plan to be forwarded to the
Governor.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for adjustments to need determinations in
the North Carolina State Medical Facilities Plan will be made no later than the date of the final
Council meeting of the calendar year.
Scheduled State Health Coordinating Council Meetings and Committee Meetings
Any changes to Council, Committee, Work Group and Public Hearing meeting dates, times and
locations will be posted on the meeting information web page at:
http://www.ncdhhs.gov/dhsr/mfp/meetings.html
North Carolina State Health Coordinating Council
March 2, 2011 The Jane S. McKimmon Ctr. 10:00 a.m.
(Wednesday) 1101 Gorman Street
Raleigh, NC 27695
May 25, 2011 To Be Determined 10:00 a.m.
(Wednesday)
September 28, 2011 To Be Determined 10:00 a.m.
(Wednesday)
http://mckimmon.ncsu.edu/mckimmon/directions.html
The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2012 State Medical Facilities Plan
immediately following the business meeting on March 2, 2011.
Acute Care Committee
April 13, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
May 4, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 14, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Long Term and Behavior Health Committee
May 6, 2011 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 16, 2011 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Technology and Equipment Committee
April 20, 2011 Dorothea Dix Campu 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
May 11, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 7, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
QAV Committee
April 6, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 15, 2011 Dorothea Dix Campus 10:00 a.m.
(Thursday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Deadlines for Petitions and Comments, and Public Hearing Schedule
Any changes to Council, Committee and Public Hearing meeting dates, times and locations will
be posted on the meeting web page: http://www.ncdhhs.gov/dhsr/mfp/meetings.html.
The deadline for receipt by the Medical Facilities Planning Section (MFPS) of petitions, written
comments and written comments on petitions and comments is 5:00 p.m. on dates listed below.
March 2, 2011 The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2012 State Medical Facilities Plan
(SMFP) immediately following the business meeting.
March 2, 2011 Deadline for receipt of petitions for changes in basic policies and methodologies
and other written comments regarding the Proposed 2012 North Carolina State
Medical Facilities Plan
March 23, 2011 Deadline for receipt by the MFPS of written comments about Acute
Care Services related petitions and comments.
March 23, 2011 Deadline for receipt by the MFPS of written comments about Quality,
Access, and Value related petitions and comments.
March 30, 2011 Deadline for receipt by the MFPS of written comments about
Technology & Equipment related petitions and comments.
April 21, 2011 Deadline for receipt by the MFPS of written comments about Long-
Term and Behavioral Health related petitions and comments.
2011 Schedule for Public Hearings on the Proposed 2012 SMFP
(all hearings begin at 1:30 p.m.)
July 13, 2011 Greensboro Greensboro Area Health Education Center
July 15, 2011 Charlotte Carolinas College of Health Sciences
July 19, 2011 Greenville Pitt County Office Bldg.
July 26, 2011 Wilmington Coastal Area Health Education Center
July 29, 2011 Asheville Mountain Area Health Education Center
August 1, 2011 Raleigh Jane S. McKimmon Center
August 1, 2011 Deadline for receipt by MFPS of petitions for adjustments to need
determinations and other written comments regarding the Proposed
2012 SMFP.
August 17, 2011 Deadline for receipt by the MFPS of written comments about
Technology & Equipment related petitions and comments.
August 19, 2011 Deadline for receipt by the MFPS of written comments about Acute
Care Services related petitions and comments.
September 2, 2011 Deadline for receipt by the MFPS of written comments about Long
Term and Behavioral Health related petitions and comments.
September 2, 2011 Deadline for receipt by the MFPS of written comments about
Quality, Access and Value related petitions and comments.
Chapter 3:
Certificate of Need Review Categories and Schedule
CHAPTER 3
CERTIFICATE OF NEED REVIEW CATEGORIES AND SCHEDULE
Certificates of need are required prior to the development of new institutional health
services identified as needed in the North Carolina State Medical Facilities Plan. The Certificate
of Need Section shall determine the appropriate review category or categories in which an
application shall be submitted pursuant to 10A NCAC 14C .0202. For proposals which include
more than one category, an applicant must contact the Certificate of Need Section prior to
submittal of the application for a determination regarding the appropriate review category or
categories and the applicable review period in which the proposal must be submitted.
The categories are as follows:
Category A
Proposals submitted by acute care hospitals, except those proposals included in
Categories B through M.
Category B
Proposals to increase the number of nursing care or adult care home beds in a
county for which there is a need determination for additional beds; and proposals
for new continuing care retirement communities applying for exemption under
Policy NH-2 or Policy LTC-1.
Category C
Proposals for new psychiatric facilities; psychiatric beds in existing health care
facilities; new intermediate care facilities for the mentally retarded (ICF/MR) and
ICF/MR beds in existing health care facilities; new substance abuse and chemical
dependency treatment facilities and substance abuse and chemical dependency
treatment beds in existing health care facilities; and transfer of nursing care beds
from state psychiatric hospitals to local communities pursuant to Policy NH-5,
psychiatric beds from state psychatric hospitals to community facilities pursuant
to Policy PSY-1, and ICF/MR beds from state developmental centers to
community facilities pursuant to Chapter 858 of the 1983 Session Laws or Policy
ICF/MR-2.
Category D
Proposals for new dialysis stations in response to the “County Need” or “Facility
Need” methodologies; and relocation of existing certified dialysis stations to
another county.
Category E
Proposals for inpatient rehabilitation facilities; inpatient rehabilitation beds; and
licensed ambulatory surgical facilities, including single specialty ambulatory
surgery demonstration projects; new operating rooms and relocation of existing
operating rooms, as defined in G.S. 131E-176(18c), with the exception of the
relocation of an entire existing licensed ambulatory surgical facility within the
same county which is included in Category I.
Category F
Proposals for new Medicare-certified home health agencies or offices; new
hospices; new hospice inpatient facility beds; and new hospice residential care
facility beds.
Category G
Proposals for conversion of acute care beds to nursing care beds under Policy
NH-1; and proposals for the conversion of acute care beds to long-term care
hospital beds.
Category H
Proposals for bone marrow transplantation services, burn intensive care services,
neonatal intensive care services, open heart surgery services, solid organ
transplantation services, cardiac catheterization equipment, heart-lung bypass
machines, gamma knives, lithotriptors, fixed site magnetic resonance imaging
scanners, positron emission tomography scanners, linear accelerators, simulators,
major medical equipment as defined in G.S. 131E-176(14f), and diagnostic
centers as defined in G.S. 131E-176(7a).
Category I
Proposals for: cost overruns; expansions of existing continuing care retirement
communities which are licensed by the Department of Insurance at the date the
application is filed and are applying under Policy NH-2 or Policy LTC-1 for
exemption from need determinations in Chapter 10: Nursing Care Facilities or
Chapter 11: Adult Care Homes; relocation within the same county of an entire
existing health service facility (excluding acute care hospitals); relocation within
the same county of existing licensed nursing facility beds, existing licensed adult
care home beds, or existing certified dialysis stations; transfer of continuing care
retirement community beds pursuant to Policy NH-7; reallocation of beds or
services pursuant to Policy Gen-1; Category A or Policy AC-3 projects submitted
by Academic Medical Center Teaching Hospitals designated prior to January 1,
1990; acquisition of replacement equipment that does not result in an increase in
the inventory of the equipment; and, any other project not included in Categories
A through H or Categories J through M.
Category J
Proposals for: demonstration projects; statewide magnetic resonance imaging
scanner need determinations; and relocation of existing adult care home or
nursing facility beds, pursuant to Policy NH-4, NH-6 or LTC-2, to a different
county which does not have a need determination for additional beds; and any
new institutional health service, as defined in N.C.G.S. 131E-176(16), that is
proposed to be developed or offered in Gates, Graham, Hoke and Hyde counties,
with the exception of proposals in Category D or I.
Category K
Proposals for new or additional acute care beds in the acute care service area;
relocation of one or more existing licensed acute care beds to a different site
within the same acute care service area, except proposals included in Category J;
and new long-term care hospital beds.
Category L
Proposals for new mobile magnetic resonance imaging scanners.
Category M
Proposals for new or additional gastrointestinal endoscopy rooms as defined in
G.S. 131E-176(7d) and relocation of existing gastrointestinal endoscopy rooms as
set forth in G.S. 131E-176(16)u, with the excepton of the relocation of an entire
existing licensed ambulatory surgical facility within the same county which is
included in Category I.
Review Dates
Table 3A shows the review schedule, by category, for certificate of need applications
requiring review. However, a service, facility, or equipment for which a need determination is
identified in the North Carolina State Medical Facilities Plan will have only one scheduled
review date and one corresponding application filing deadline in the calendar year, even though
the table shows multiple review dates for the broad category. In order to determine the
designated filing deadline for a specific need determination in the North Carolina State Medical
Facilities Plan, an applicant must refer to the applicable need determination table for that service
in the related chapter in the Plan. Applications for certificates of need for new institutional health
services not specified in other chapters of the Plan shall be reviewed pursuant to the following
review schedule, with the exception that no reviews are scheduled if the need determination is
zero. Need determinations for additional dialysis stations pursuant to the “county need” or
“facility need” methodologies shall be reviewed in accordance with the provisions of Chapter 14.
In order to give the Certificate of Need Section sufficient time to provide public
notice of review and public notice of public hearings as required by G.S. 131E-185, the
deadline for filing certificate of need applications is 5:30 p.m. on the 15th day of the month
preceding the “CON Beginning Review Date.” In instances when the 15th day of the month
falls on a weekend or holiday, the filing deadline is 5:30 p.m. on the next business day. The
filing deadline is absolute and applications received after the deadline shall not be reviewed
in that review period. Applicants are strongly encouraged to complete all materials at least
one day prior to the filing deadline and to submit material early on the “Certificate of Need
Application Due Date.”
Table 3A: 2011 Certificate of Need Review Schedule
CON Beginning
Review Date
Health Service Area
I, II, III
Health Service Area
IV, V, VI
January 1, 2011 -- --
February 1, 2011 A, B, C, G, H, I --
March 1, 2011 -- A, B, C, E, G, H, I
April 1, 2011 C, D, E, F, H, I, K(1), M(1) D
May 1, 2011 C, E, F, H, I, K(4), M(4)
June 1, 2011 A, B, C, F, H, I
July 1, 2011 J A, B, C, E, H, I, J, K(5), M(5)
August 1, 2011 B, C, E, F, H, I, K(2), M(2) --
September 1, 2011 -- B, C, E, F, H, I
October 1, 2011 A, C, D, F, H, I D
November 1, 2011 B, C, E, H, I, L, K(3), M(3) --
December 1, 2011 -- A, B, C, E, F, H, I, L, K(6), M(6)
(1) HSA I only.
(2) HSA II only.
(3) HSA III only.
(4) HSA IV only.
(5) HSA V only.
(6) HSA VI only.
For further information about specific schedules, timetables, and certificate of need
application forms, contact:
North Carolina Division of Health Service Regulation
Certificate of Need Section
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
Phone: (919) 855-3873
Chapter 4:
Statement of Policies:
• Acute Care Hospitals
• Nursing Care Facilities
• Adult Care Homes
• Home Health Services
• End-Stage Renal Disease Dialysis Services
• Mental Health, Developmental Disabilities,
and Substance Abuse (General)
• Psychiatric Inpatient Services
• Intermediate Care Facilities for the Mentally Retarded
• All Health Services
CHAPTER 4
STATEMENT OF POLICIES
Summary of Policy Changes for 2011
Two substantive policy changes have been recommended for incorporation into the North
Carolina 2011 State Medical Facilities Plan. POLICY AC-5: REPLACEMENT OF ACUTE
CARE BED CAPACITY has been revised to include swing bed days when calculating Policy
AC-5 target occupancy rates for proposals to replace acute care beds in Critical Access
Hospitals.
POLICY GEN-4: ENERGY EFFICIENCY AND SUSTAINABLE BUILDING DESIGN
AND CONSTRUCTION is a preliminary energy policy developed in response to the Governor’s
directive to address more energy efficient and sustainable building design and construction for
certificate of need applicants proposing new or replacement health care facilities. Policy Gen-4
will continue to be expanded for future North Carolina State Medical Facility Plans.
Throughout Chapter 4, references to dates have been advanced by one year, as appropriate.
POLICIES APPLICABLE TO ACUTE CARE HOSPITALS (AC)
POLICY AC-1: USE OF LICENSED BED CAPACITY DATA FOR PLANNING
PURPOSES
For planning purposes the number of licensed beds shall be determined by the Division
of Health Service Regulation in accordance with standards found in 10A NCAC 13B - Section
.6200 and Section .3102 (d).
Licensed bed capacity of each hospital is used for planning purposes. It is the hospital's
responsibility to notify the Division of Health Service Regulation promptly when any of the
space allocated to its licensed bed capacity is converted to another use, including purposes not
directly related to health care.
POLICY AC-3: EXEMPTION FROM PLAN PROVISIONS FOR CERTAIN
ACADEMIC MEDICAL CENTER TEACHING HOSPITAL PROJECTS
Projects for which certificates of need are sought by academic medical center teaching
hospitals may qualify for exemption from the need determinations of this document. The
Medical Facilities Planning Section shall designate as an Academic Medical Center Teaching
Hospital any facility whose application for such designation demonstrates the following
characteristics of the hospital:
1. Serves as a primary teaching site for a school of medicine and at least one
other health professional school, providing undergraduate, graduate and
postgraduate education.
2. Houses extensive basic medical science and clinical research programs,
patients and equipment.
3. Serves the treatment needs of patients from a broad geographic area
through multiple medical specialties.
Exemption from the provisions of need determinations of the North Carolina State
Medical Facilities Plan shall be granted to projects submitted by Academic Medical Center
Teaching Hospitals designated prior to January 1, 1990 provided the projects comply with one of
the following conditions:
1. Necessary to complement a specified and approved expansion of the
number or types of students, residents or faculty, as certified by the head
of the relevant associated professional school; or
2. Necessary to accommodate patients, staff or equipment for a specified and
approved expansion of research activities, as certified by the head of the
entity sponsoring the research; or
3. Necessary to accommodate changes in requirements of specialty education
accrediting bodies, as evidenced by copies of documents issued by such
bodies.
A project submitted by an Academic Medical Center Teaching Hospital under this Policy
that meets one of the above conditions shall also demonstrate that the Academic Medical Center
Teaching Hospital’s teaching or research need for the proposed project cannot be achieved
effectively at any non-Academic Medical Center Teaching Hospital provider which currently
offers the service for which the exemption is requested and which is within 20 miles of the
Academic Medical Center Teaching Hospital.
Any health service facility or health service facility bed that results from a project
submitted under this Policy after January 1, 1999 shall be excluded from the inventory of that
health service facility or health service facility beds in the North Carolina State Medical
Facilities Plan.
POLICY AC-4: RECONVERSION TO ACUTE CARE
Facilities that have redistributed beds from acute care bed capacity to psychiatric,
rehabilitation, nursing care, or long-term care hospital use, shall obtain a certificate of need to
convert this capacity back to acute care. Applicants proposing to reconvert psychiatric,
rehabilitation, nursing care, or long-term care hospital beds back to acute care beds shall
demonstrate that the hospital’s average annual utilization of licensed acute care beds as
calculated using the most recent Thomson Reuters Days of Care as provided to the Medical
Facilities Planning Section by The Cecil G. Sheps Center for Health Services Research at the
University of North Carolina at Chapel Hill, is equal to or greater than the target occupancies
shown below, but shall not be evaluated against the acute care bed need determinations shown in
Chapter 5 of the North Carolina State Medical Facilities Plan. In determining utilization rates
and average daily census, only acute care bed “days of care” are counted.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-5: REPLACEMENT OF ACUTE CARE BED CAPACITY
Proposals for either partial or total replacement of acute care beds (i.e., construction of
new space for existing acute care beds) shall be evaluated against the utilization of the total
number of acute care beds in the applicant’s hospital in relation to utilization targets found
below. For hospitals not designated by the Center for Medicare and Medicaid Services as
Critical Access Hospitals, in determining utilization of acute care beds, only acute care bed
“days of care” shall be counted. For hospitals designated by the Center for Medicare and
Medicaid Services as Critical Access Hospitals, in determining utilization of acute care beds,
only acute care bed “days of care” and swing bed days (i.e., nursing facility days of care) shall
be counted in determining utilization of acute care beds. Any hospital proposing replacement of
acute care beds must clearly demonstrate the need for maintaining the acute care bed capacity
proposed within the application. Additionally, if the hospital is a Critical Access Hospital and
swing bed days are proposed to be counted in determining utilization of acute care beds, the
hospital shall also propose to remain a Critical Access Hospital and must demonstrate the need
for maintaining the swing bed capacity proposed within the application. If the Critical Access
Hospital does not propose to remain a Critical Access Hospital, only acute care bed “days of
care” shall be counted in determining utilization of acute care beds and the hospital must clearly
demonstrate the need for maintaining the acute care bed capacity proposed within the
application.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-6: HEART-LUNG BYPASS MACHINES FOR EMERGENCY COVERAGE
To protect cardiac surgery patients, who may require emergency procedures while
scheduled procedures are under way, a need is determined for one additional heart-lung bypass
machine whenever a hospital is operating an open heart surgery program with only one heart-lung
bypass machine. The additional machine is to be used to assure appropriate coverage for
emergencies and in no instance shall this machine be scheduled for use at the same time as the
machine used to support scheduled open heart surgery procedures. A certificate of need
application for a machine acquired in accordance with this provision shall be exempt from
compliance with the performance standards set forth in 10A NCAC 14C .1703(2).
POLICIES APPLICABLE TO NURSING CARE FACILITIES (NH)
POLICY NH-1: PROVISION OF HOSPITAL-BASED NURSING CARE
A certificate of need may be issued to a hospital which is licensed under G.S. 131E,
Article 5, and which meets the conditions set forth below and in 10A NCAC 14C .1100, to
convert up to 10 beds from its licensed acute care bed capacity for use as hospital-based nursing
care beds without regard to determinations of need in Chapter 10: Nursing Care Facilities, if the
hospital:
1. is located in a county which was designated as non-metropolitan by the
U.S. Office of Management and Budget on January 1, 2011; and
2. on January 1, 2011, had a licensed acute care bed capacity of 150 beds or
less.
The certificate of need shall remain in force as long as the North Carolina Department of
Health and Human Services determines that the hospital is meeting the conditions outlined in
this policy.
"Hospital-based nursing care" is defined as nursing care provided to a patient who has
been directly discharged from an acute care bed and cannot be immediately placed in a licensed
nursing facility because of the unavailability of a bed appropriate for the individual's needs.
Nursing care beds developed under this policy are intended to provide placement for
residents only when placement in other nursing care beds is unavailable in the geographic area.
Hospitals which develop nursing care beds under this policy shall discharge patients to other
nursing facilities with available beds in the geographic area as soon as possible where
appropriate and permissible under applicable law. Necessary documentation, including copies of
physician referral forms (FL 2) on all patients in hospital-based nursing units, shall be made
available for review upon request by duly authorized representatives of licensed nursing
facilities.
For purposes of this policy, beds in hospital-based nursing care shall be certified as a
"distinct part" as defined by the Centers for Medicare and Medicaid Services. Nursing care beds
in a "distinct part" shall be converted from the existing licensed acute care bed capacity of the
hospital and shall not be reconverted to any other category or type of bed without a certificate of
need.
An application for a certificate of need for reconverting beds to acute care shall be
evaluated against the hospital's service needs utilizing target occupancies shown in Policy AC-4,
without regard to the acute care bed need shown in Chapter 5: Acute Care Hospital Beds. A
certificate of need issued for a hospital-based nursing care unit shall remain in force as long as
the following conditions are met:
1. The nursing care beds shall be certified for participation in the Title XVIII
(Medicare) and Title XIX (Medicaid) programs;
2. The hospital discharges residents to other nursing facilities in the
geographic area with available beds when such discharge is appropriate
and permissible under applicable law;
3. Patients admitted shall have been acutely ill inpatients of an acute hospital
or its satellites immediately preceding placement in the nursing care unit.
The granting of beds for hospital-based nursing care shall not allow a hospital to convert
additional beds without first obtaining a certificate of need. Where any hospital, or the parent
corporation or entity of such hospital, any subsidiary corporation or entity of such hospital, or
any corporation or entity related to or affiliated with such hospital by common ownership,
control or management:
1. Applies for and receives a certificate of need for nursing care bed need
determinations in Chapter 10 of the North Carolina State Medical
Facilities Plan, or
2. Currently has nursing home beds licensed as a part of the hospital under
G.S. 131E, Article 5, or
3. Currently operates nursing care beds under the Federal Swing Bed
Program (P.L. 96-499),
Such hospital shall not be eligible to apply for a certificate of need for hospital-based
nursing care beds under this policy. Hospitals designated by the State of North Carolina as
Critical Access Hospitals pursuant to section 1820 (f) of the Social Security Act, as amended,
which have not been allocated nursing care beds under provisions of G.S. 131E 175-190, may
apply to develop beds under this policy. However, such hospitals shall not develop nursing care
beds both to meet needs determined in Chapter 10 of the North Carolina State Medical Facilities
Plan and this policy.
Beds certified as a "distinct part" under this policy shall be counted in the inventory of
existing nursing care beds and used in the calculation of unmet nursing care bed need for the
general population of a planning area.
Applications for certificates of need pursuant to this policy shall be accepted only for the
February 1 review cycle for Health Service Areas I, II and III, and for the March 1 review cycle
for Health Service Areas IV, V and VI. Nursing care beds awarded under this policy shall be
deducted from need determinations for the county as shown in Chapter 10: Nursing Care
Facilities.
Continuation of this policy shall be reviewed and approved by the North Carolina
Department of Health and Human Services annually. Certificates of need issued under policies
analogous to this policy in the North Carolina State Medical Facilities Plans subsequent to the
1986 Plan are automatically amended to conform with the provisions of this policy at the
effective date of this policy.
The North Carolina Department of Health and Human Services shall monitor this
program and ensure that patients affected by this policy are receiving services as indicated by
their care plan, and that conditions under which the certificate of need was granted are being
met.
POLICY NH-2: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for nursing care without regard to the nursing care bed need shown in
Chapter 10: Nursing Care Facilities. To qualify for such exemption, applications for certificates
of need shall show that the proposed nursing care bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of facilities for both of the following levels of care:
a. independent living accommodations (apartments and homes) for
people who are able to carry out normal activities of daily living
without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms;
b. licensed adult care home beds for use by people who, because of
age or disability require some personal services, incidental
medical services, and room and board to assure their safety and
comfort.
2. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing unit of the continuing care retirement community for a period
of at least 30 days. Exceptions shall be allowed when one spouse or
sibling is admitted to the nursing unit at the time the other spouse or
sibling moves into a non-nursing unit, or when the medical condition
requiring nursing care was not known to exist or be imminent when the
individual became a party to the continuing care contract.
3. Reflects the number of nursing care beds required to meet the current or
projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional nursing care.
4. Will not be certified for participation in the Medicaid program.
One half of the nursing care beds developed under this exemption shall be excluded from
the inventory used to project nursing care bed need for the general population. Certificates of
need issued under policies analogous to this policy in the North Carolina State Medical Facilities
Plans subsequent to the 1985 State Medical Facilities Plan are automatically amended to
conform with the provisions of this policy at the effective date of this policy. Certificates of
need awarded pursuant to the provisions of Chapter 920, Session Laws 1983 or Chapter 445,
Session Laws 1985 shall not be amended.
POLICY NH-3: DETERMINATION OF NEED FOR ADDITIONAL NURSING
CARE BEDS IN SINGLE PROVIDER COUNTIES
When a nursing care facility with fewer than 80 nursing care beds is the only nursing care
facility within a county, it may apply for a certificate of need for additional nursing care beds in
order to bring the minimum number of nursing care beds available within the county to no more
than 80 nursing care beds without regard to the nursing care bed need determination for that
county as listed in Chapter 10: Nursing Care Facilities.
POLICY NH-4: RELOCATION OF CERTAIN NURSING FACILITY BEDS
A certificate of need to relocate existing licensed nursing facility beds to another
county(ies) may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1, provided that the conditions set forth below and in 10A NCAC 14C .1100 and
the review criteria in G.S. 131E-183(a) are met. A facility applying for a certificate of need to
relocate nursing facility beds shall demonstrate that:
1. It is a non-profit nursing facility supported by and directly affiliated with a
particular religion and that it is the only nursing facility in North Carolina
supported by and affiliated with that religion;
2. The primary purpose for the nursing facility’s existence is to provide long-term
care to followers of the specified religion in an environment which
emphasizes religious customs, ceremonies, and practices;
3. Relocation of the nursing facility beds to one or more sites is necessary to
more effectively provide nursing care to followers of the specified religion
in an environment which emphasizes religious customs, ceremonies, and
practices;
4. The nursing facility is expected to serve followers of the specified religion
from a multi-county area; and
5. The needs of the population presently served shall be met adequately
pursuant to G.S. 131E-183.
Exemption from the need determinations in Chapter 10: Nursing Care Facilities shall be
granted to a nursing facility for purposes of relocating existing licensed nursing care beds to
another county provided that it complies with all of the criteria listed in Subparts 1 through 5
above.
Any certificate of need issued under this policy shall be subject to the following conditions:
1. The nursing facility shall relocate beds in at least two stages over a period
of at least six months or such shorter period of time as is necessary to
transfer residents desiring to transfer to the new facility and otherwise
make discharge arrangements acceptable to residents not desiring to
transfer to the new facility; and
2. The nursing facility shall provide a letter to the Licensure and
Certification Section, on or before the date that the first group of beds are
relocated, irrevocably committing the facility to relocate all of the nursing
facility beds for which it has a certificate of need to relocate; and
3. Subsequent to providing the letter to the Licensure and Certification
Section described in Subsection 2 above, the nursing facility shall accept
no new patients in the beds which are being relocated, except new patients
who, prior to admission, indicate their desire to transfer to the facility’s
new location(s).
POLICY NH-5: TRANSFER OF NURSING FACILITY BEDS FROM STATE
PSYCHIATRIC HOSPITAL NURSING FACILITIES TO COMMUNITY
FACILITIES
Beds in state psychiatric hospitals that are certified as nursing facility beds may be
relocated to licensed nursing facilities. However, before nursing facility beds are transferred out
of the state psychiatric hospitals, services shall be available in the community. State psychiatric
hospital nursing facility beds that are relocated to licensed nursing facilities shall be closed
within 90 days following the date the transferred beds become operational in the community.
Licensed nursing facilities proposing to operate transferred nursing facility beds shall
commit to serve the type of residents who are normally placed in nursing facility beds at the state
psychiatric hospitals. To help ensure that relocated nursing facility beds will serve those people
who would have been served by state psychiatric hospitals in nursing facility beds, a certificate
of need application to transfer nursing facility beds from a state hospital shall include a written
memorandum of agreement between the director of the applicable state psychiatric hospital; the
director of the North Carolina Division of State Operated Healthcare Facilities; the secretary of
the North Carolina Department of Health and Human Services; and the person submitting the
proposal.
This policy does not allow the development of new nursing care beds. Nursing care beds
transferred from state psychiatric hospitals to the community pursuant to Policy NH-5 shall be
excluded from the inventory.
POLICY NH-6: RELOCATION OF NURSING FACILITY BEDS
Relocations of existing licensed nursing facility beds are allowed only within the host
county and to contiguous counties currently served by the facility, except as provided in Policies
NH-4, NH-5 and NH-7. Certificate of need applicants proposing to relocate licensed nursing
facility beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed nursing facility beds in the county that would be losing nursing
facility beds as a result of the proposed project, as reflected in the North
Carolina State Medical Facilities Plan in effect at the time the certificate
of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed
nursing facility beds in the county that would gain nursing facility beds as
a result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICY NH-7: TRANSFER OF CONTINUING CARE RETIREMENT COMMUNITY
BEDS
A certificate of need to relocate existing licensed nursing beds to another county or
counties may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1 without regard to the nursing care bed need shown in Chapter 10, provided that
the following conditions are met:
1. Any certificate of need application filed pursuant to this policy must
satisfy:
a. the regulatory review criteria in 10A NCAC 14C.1100, except the
performance standards in 10A NCAC 14C.1102(a) and (b); and
b. the review criteria in G.S. 131E-183(a).
2. The nursing facility receiving the beds (“the receiving facility”) must:
a. be part of a not-for-profit continuing care retirement community
(CCRC);
b. be part of a CCRC which is affiliated through ownership,
governance, or leasehold with a not-for-profit organization which
provides long-term care to residents;
c. provide CCRC services to residents from multiple counties in
addition to the county in which the facility is located; and
d. use the transferred beds exclusively to meet the needs of people
either eligible for Medicaid or eligible for Medicaid within 45 days
of admission to the nursing facility bed with whom the facility has
continuing care contracts (in compliance with the North Carolina
Department of Insurance statutes and rules) who have lived in a non-nursing
unit of the continuing care retirement community for a period of at
least 30 days.
3. The nursing facility transferring the beds (“the transferring facility”) must
be a CCRC affiliated through ownership, governance or leasehold with the
same not-for-profit organization as the receiving facility.
4. The transferred beds shall not have been originally approved through the
certificate of need process on or after January 1, 1976 and shall have been
eligible prior to January 1, 1976 to be certified for Medicaid.
5. No more than five beds may be transferred to any single nursing facility
pursuant to this policy during any consecutive three-year period.
6. Certificate of need applicants proposing to relocate licensed nursing
facility beds under this policy shall demonstrate that the proposal will not
result in a deficit in the number of licensed nursing facility beds in the
county that would be losing nursing facility beds as a result of the
proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins.
7. Nursing facility beds relocated under this policy shall be counted in the
planning inventory of the receiving county.
POLICY NH-8: INNOVATIONS IN NURSING FACILITY DESIGN
Certificate of need applicants proposing new nursing facilities, replacement nursing
facilities, and projects associated with the expansion and/or renovation of existing nursing
facilities shall pursue innovative approaches in care practices, work place practices and
environmental design that address quality of care and quality of life needs of the residents.
These plans could include innovative design elements that encourage less institutional, more
home-like settings, privacy, autonomy and resident choice, among others.
POLICIES APPLICABLE TO ADULT CARE HOMES
POLICY LTC-1: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES – Adult Care Home Beds
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for adult care without regard to the adult care home bed need shown in
Chapter 11: Adult Care Homes. To qualify for such exemption, applications for certificates of
need shall show that the proposed adult care home bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of independent living accommodations (apartments and
homes) for people who are able to carry out normal activities of daily
living without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms.
2. Will provide for the provision of nursing services, medical services, or
other health related services as required for licensure by the North
Carolina Department of Insurance.
3. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing or adult care unit of the continuing care retirement
community for a period of at least 30 days. Exceptions shall be allowed
when one spouse or sibling is admitted to the adult care home unit at the
time the other spouse or sibling moves into a non-nursing or adult care
unit, or when the medical condition requiring nursing or adult care home
care was not known to exist or be imminent when the individual became a
party to the continuing care contract.
4. Reflects the number of adult care home beds required to meet the current
or projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional adult care home care.
5. Will not participate in the Medicaid program or serve State-County
Special Assistance recipients.
One half of the adult care home beds developed under this exemption shall be excluded
from the inventory used to project adult care home bed need for the general population.
Certificates of need issued under policies analogous to this policy in the North Carolina State
Medical Facilities Plans subsequent to the North Carolina 2002 State Medical Facilities Plan are
automatically amended to conform with the provisions of this policy at the effective date of this
policy.
POLICY LTC-2: RELOCATION OF ADULT CARE HOME BEDS
Relocations of existing licensed adult care home beds are allowed only within the host
county and to contiguous counties currently served by the facility. Certificate of need applicants
proposing to relocate licensed adult care home beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed adult care home beds in the county that would be losing adult
care home beds as a result of the proposed project, as reflected in the
North Carolina State Medical Facilities Plan in effect at the time the
certificate of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed adult
care home beds in the county that would gain adult care home beds as a
result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICIES APPLICABLE TO HOME HEALTH SERVICES (HH)
POLICY HH-3: NEED DETERMINATION FOR MEDICARE-CERTIFIED HOME
AGENCY IN A COUNTY
When a county has no Medicare-certified home health agency office physically located
within the county’s borders, and the county has a population of more than 20,000 people; or, if
the county has a population of less than 20,000 people and there is not an existing Medicare-certified
home health agency office located in a North Carolina county within 20 miles, need for
a new Medicare-certified home health agency office in the county is thereby established through
this policy. The “need determination” shall be reflected in the next annual North Carolina State
Medical Facilities Plan that is published following determination that a county meets the criteria
indicated above. (Population is based on population estimates/projections from the North
Carolina Office of State Budget and Management for the plan year in which the need
determination would be made excluding active duty military for any county with more than 500
active duty military personnel. The measurement of 20 miles will be in a straight line from the
closest point on the county line of the county in which an existing agency office is located to the
county seat of the county in which there is no agency.)
POLICIES RELATED TO END-STAGE RENAL DISEASE DIALYSIS SERVICES
(ESRD)
POLICY ESRD-2: RELOCATION OF DIALYSIS STATIONS
Relocations of existing dialysis stations are allowed only within the host county and to
contiguous counties currently served by the facility. Certificate of need applicants proposing to
relocate dialysis stations to contiguous counties shall:
1. demonstrate that the proposal shall not result in a deficit in the number of
Dialysis stations in the county that would be losing stations as a result of
the proposed project, as reflected in the most recent North Carolina
Semiannual Dialysis Report, and
2. demonstrate that the proposal shall not result in a surplus of dialysis
stations in the county that would gain stations as a result of the proposed
project, as reflected in the most recent North Carolina Semiannual
Dialysis Report.
GENERAL POLICY APPLICABLE TO ALL MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE FACILITIES (MH)
POLICY MH-1: LINKAGES BETWEEN TREATMENT SETTINGS
An applicant for a certificate of need for psychiatric, substance abuse, or Intermediate
Care Facilities for the Mentally Retarded beds shall document that the affected local
management entity has been contacted and invited to comment on the proposed services.
POLICIES APPLICABLE TO PSYCHIATRIC INPATIENT SERVICES FACILITIES
(PSY)
POLICY PSY-1: TRANSFER OF BEDS FROM STATE PSYCHIATRIC
HOSPITALS TO COMMUNITY FACILITIES
Beds in the state psychiatric hospitals used to serve short-term psychiatric patients may
be relocated to community facilities through the certificate of need process. However, before
beds are transferred out of the state psychiatric hospitals, services and programs shall be
available in the community. State psychiatric hospital beds that are relocated to community
facilities shall be closed within 90 days following the date the transferred beds become
operational in the community.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section of the North Carolina Department of Health and Human Services and
commit to serve the type of short-term patients normally placed at the state psychiatric hospitals.
To help ensure that relocated beds will serve those people who would have been served by the
state psychiatric hospitals, a proposal to transfer beds from a state hospital shall include a written
memorandum of agreement between the local management entity serving the county where the
beds are to be located, the secretary of the North Carolina Department of Health and Human
Services, and the person submitting the proposal.
POLICIES APPLICABLE TO INTERMEDIATE CARE FACILITIES FOR THE
MENTALLY RETARDED (ICF/MR)
POLICY ICF/MR-1: TRANSFER OF ICF/MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR MEDICALLY
FRAGILE CHILDREN
Intermediate Care Facilities for the Mentally Retarded (ICF/MR) beds in state operated
developmental centers may be relocated to community facilities through the certificate of need
process for the establishment of community ICF/MR facilities to serve children ages birth
through six years who have severe to profound developmental disabilities and are medically
fragile. This policy allows for the relocation or transfer of beds only and does not provide for
transfer of residents with the beds. State operated developmental center ICF/MR beds that are
relocated to community facilities shall be closed upon licensure of the transferred beds.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section demonstrating a commitment to serve children ages birth through six
years who have severe to profound developmental disabilities and are medically fragile. To help
ensure the relocated beds will serve these residents such proposal shall include a written
agreement with the following representatives: director of the local management entity serving
the county where the group home is to be located; the director of the applicable state operated
developmental center; the director of the North Carolina Division of State Operated Healthcare
Facilities; the secretary of the North Carolina Department of Health and Human Services and the
operator of the group home.
POLICY ICF/MR-2: TRANSFER OF ICF/MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR INDIVIDUALS
WHO CURRENTLY OCCUPY THE BEDS
Existing certified Intermediate Care Facilities for the Mentally Retarded (ICF/MR) beds
in state operated developmental centers may be transferred through the certificate of need
process to establish ICF/MR group homes in the community to serve people with complex
behavioral challenges and/or medical conditions for whom a community ICF/MR placement is
appropriate, as determined by the individual’s treatment team and with the individual/guardian
being in favor of the placement. This policy requires the transfer of the individuals who
currently occupy the ICF/MR beds in the developmental center to the community facility when
the beds are transferred. The beds in the state operated developmental center shall be closed
upon certification of the transferred ICF/MR beds in the community facility. Providers
proposing to develop transferred ICF/MR beds, as those beds are described in this policy, shall
submit an application to the Certificate of Need Section that demonstrates their clinical
experience in treating individuals with complex behavioral challenges or medical conditions in a
residential ICF/MR setting. To ensure the transferred beds will be used to serve these
individuals, a written agreement between the following parties shall be obtained prior to
development of the group home: director of the local management entity serving the county
where the group home is to be located, the director of the applicable developmental center, the
director of the North Carolina Division of State Operated Healthcare Facilities, the secretary of
the North Carolina Department of Health and Human Services and the operator of the group
home.
POLICIES APPLICABLE TO ALL HEALTH SERVICES (GEN)
The policy statements below apply to all health services including acute care (hospitals,
ambulatory surgical facilities, operating rooms, rehabilitation facilities, and technology); long-term
care (nursing homes, adult care homes, Medicare-certified home health agencies, end-stage
renal disease services and hospice services); mental health (psychiatric facilities, substance
abuse facilities, and ICF/MR) and services and equipment including bone marrow
transplantation services, burn intensive care services, neonatal intensive care services, open heart
surgery services, solid organ transplantation services, cardiac catheterization equipment, heart-lung
bypass machines, gamma knives, linear accelerators, lithotriptors, magnetic resonance
imaging scanners, positron emission tomography scanners, simulators, major medical equipment
as defined in G.S. 131E-176(14f), and diagnostic centers as defined in G.S. 131E-176(7a).
POLICY GEN-1: REALLOCATIONS
1. Reallocations shall be made only to the extent that the methodologies used
in this Plan to make need determinations indicate that need exists after the
inventories are revised and the need determinations are recalculated.
2. Beds or services which are reallocated once in accordance with this policy
shall not be reallocated again. Rather, the Medical Facilities Planning
Section shall make any necessary changes in the next annual North
Carolina State Medical Facilities Plan.
3. Dialysis stations that are withdrawn, relinquished, not applied for,
decertified, denied, appealed, or pending the expiration of the 30-day
appeal period shall not be reallocated. Instead, any necessary
redetermination of need shall be made in the next scheduled publication of
the North Carolina Semiannual Dialysis Report.
4. Appeals of Certificate of Need Decisions on Applications
Need determinations of beds or services for which the Certificate of Need
Section decision to approve or deny the application has been appealed
shall not be reallocated until the appeal is resolved.
a. Appeals resolved prior to August 17:
If such an appeal is resolved in the calendar year prior to August
17, the beds or services shall not be reallocated by the Certificate
of Need Section; rather the Medical Facilities Planning Section
shall make the necessary changes in the next annual North
Carolina State Medical Facilities Plan except for dialysis stations
which shall be processed pursuant to Item 3.
b. Appeals resolved on or after August 17:
If such an appeal is resolved on or after August 17 in the calendar
year, the beds or services, except for dialysis stations, shall be
made available for a review period to be determined by the
Certificate of Need Section, but beginning no earlier than 60 days
from the date that the appeal is resolved. Notice shall be mailed by
the Certificate of Need Section to all people on the mailing list for
the North Carolina State Medical Facilities Plan, no less than 45
days prior to the due date for receipt of new applications.
5. Withdrawals and Relinquishments
Except for dialysis stations, a need determination for which a certificate of
need is issued, but is subsequently withdrawn or relinquished, is available
for a review period to be determined by the Certificate of Need Section,
but beginning no earlier than 60 days from:
a. the last date on which an appeal of the notice of intent to withdraw
the certificate could be filed if no appeal is filed,
b. the date on which an appeal of the withdrawal is finally resolved
against the holder, or
c. the date that the Certificate of Need Section receives from the
holder of the certificate of need notice that the certificate has been
voluntarily relinquished.
Notice of the scheduled review period for the reallocated services or beds
shall be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no less
than 45 days prior to the due date for submittal of the new applications.
6. Need Determinations for which No Applications are Received
a. Services or beds with scheduled review in the calendar year on or
before September 1: The Certificate of Need Section shall not
reallocate the services or beds in this category for which no
applications were received, because the Medical Facilities
Planning Section will have sufficient time to make any necessary
changes in the determinations of need for these services or beds in
the next annual North Carolina State Medical Facilities Plan,
except for dialysis stations.
b. Services or beds with scheduled review in the calendar year after
September 1: Except for dialysis stations, a need determination in
this category for which no application has been received by the last
due date for submittal of applications shall be available to be
applied for in the second Category I review period in the next
calendar year for the applicable Health Service Area. Notice of the
scheduled review period for the reallocated beds or services shall
be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no
less than 45 days prior to the due date for submittal of new
applications.
7. Need Determinations not Awarded because Application Disapproved
a. Disapproval in the calendar year prior to August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section before August 17, shall not be reallocated by the
Certificate of Need Section. Instead the Medical Facilities
Planning Section shall make the necessary changes in the next
annual North Carolina State Medical Facilities Plan if no appeal is
filed, except for dialysis stations.
b. Disapproval in the calendar year on or after August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section on or after August 17, shall be reallocated by the
Certificate of Need Section, except for dialysis stations. A need in
this category shall be available for a review period to be
determined by the Certificate of Need Section but beginning no
earlier than 95 days from the date the application was disapproved,
if no appeal is filed. Notice of the scheduled review period for the
reallocation shall be mailed by the Certificate of Need Section to
all people on the mailing list for the North Carolina State Medical
Facilities Plan no less than 80 days prior to the due date for
submittal of the new applications.
8. Reallocation of Decertified Intermediate Care Facilities for the Mentally
Retarded (ICF/MR) Beds
If an ICF/MR facility’s Medicaid certification is relinquished or revoked,
the ICF/MR beds in the facility may be reallocated by the North Carolina
Department of Health and Human Services, Division of Health Service
Regulation, Medical Facilities Planning Section after consideration of
recommendations from the North Carolina Division of Mental Health,
Developmental Disabilities, and Substance Abuse Services. The North
Carolina Department of Health and Human Services, Division of Health
Service Regulation, Certificate of Need Section shall schedule reviews of
applications for any reallocated beds pursuant to Section (5) of this policy.
POLICY GEN-2: CHANGES IN NEED DETERMINATIONS
1. The need determinations adopted in this document or in the Dialysis
Reports shall be revised continuously throughout the calendar year to
reflect all changes in the inventories of:
a. the health services listed at G.S. 131E-176 (16)f;
b. health service facilities;
c. health service facility beds;
d. dialysis stations;
e. the equipment listed at G.S. 131E-176 (16)f1;
f. mobile medical equipment; and
g. operating rooms as defined in Chapter 6;
as those changes are reported to the Medical Facilities Planning Section.
However, need determinations in this document shall not be reduced if the
relevant inventory is adjusted upward 60 days or less prior to the
applicable “Certificate of Need Application Due Date.”
2. Inventories shall be updated to reflect:
a. decertification of Medicare-certified home health agencies or
offices, ICF/MR and dialysis stations;
b. delicensure of health service facilities and health service facility
beds;
c. demolition, destruction, or decommissioning of equipment as listed
at G.S. 131E-176(16)f1 and s;
d. elimination or reduction of a health service as listed at G.S. 131E-
176(16)f;
e. addition or reduction in operating rooms as defined in Chapter 6;
f. psychiatric beds licensed pursuant to G.S. 131E-184(c);
g. certificates of need awarded, relinquished, or withdrawn,
subsequent to the preparation of the inventories in the North
Carolina State Medical Facilities Plan;
h. corrections of errors in the inventory as reported to the Medical
Facilities Planning Section.
3. Any person who is interested in applying for a new institutional health
service for which a need determination is made in this document may
obtain information about updated inventories and need determinations
from the Medical Facilities Planning Section.
4. Need determinations resulting from changes in inventory shall be
available for a review period to be determined by the Certificate of Need
Section, but beginning no earlier than 60 days from the date of the action
identified in Subsection (2), except for dialysis stations which shall be
determined by the Medical Facilities Planning Section and published in
the next North Carolina Semiannual Dialysis Report. Notice of the
scheduled review period for the need determination shall be mailed by the
Certificate of Need Section to all people on the mailing list for the North
Carolina State Medical Facilities Plan no less than 45 days prior to the due
date for submittal of the new applications.
POLICY GEN-3: BASIC PRINCIPLES
A certificate of need applicant applying to develop or offer a new institutional health
service for which there is a need determination in the North Carolina State Medical Facilities
Plan shall demonstrate how the project will promote safety and quality in the delivery of health
care services while promoting equitable access and maximizing healthcare value for resources
expended. A certificate of need applicant shall document its plans for providing access to
services for patients with limited financial resources and demonstrate the availability of capacity
to provide these services. A certificate of need applicant shall also document how its projected
volumes incorporate these concepts in meeting the need identified in the State Medical Facilities
Plan as well as addressing the needs of all residents in the proposed service area.
POLICY GEN-4: ENERGY EFFICIENCY AND SUSTAINABILITY FOR HEALTH
SERVICE FACILITIES
Any person proposing a capital expenditure greater than $2 million to develop, replace,
renovate or add to a health service facility pursuant to G.S. 131E-178 shall include in its
certificate of need application a written statement describing the project’s plan to assure
improved energy efficiency and water conservation.
In approving a certificate of need proposing an expenditure greater than $5 million to
develop, replace, renovate or add to a health service facility pursuant to G.S. 131E-178, the
Certificate of Need Section shall impose a condition requiring the applicant to develop and
implement an Energy Efficiency and Sustainability Plan for the project that conforms to or
exceeds energy efficiency and water conservation standards incorporated in the latest editions of
the North Carolina State Building Codes. The plan must be consistent with the applicant’s
representation in the written statement as described in paragraph one of Policy GEN-4.
Any person awarded a certificate of need for a project or an exemption from review
pursuant to G.S. 131E-184 are required to submit a plan for energy efficiency and water
conservation that conforms to the rules, codes and standards implemented by the Construction
Section of the Division of Health Service Regulation. The plan must be consistent with the
applicant’s representation in the written statement as described in paragraph one of Policy GEN-
4. The plan shall not adversely affect patient or resident health, safety or infection control.
Chapter 5:
Acute Care Hospital Beds
CHAPTER 5
ACUTE CARE HOSPITAL BEDS
Summary of Bed Supply and Utilization
As of fall 2010, there are 114 licensed acute care hospitals and 20,647 licensed acute care
beds in North Carolina. Data provided by Thomson Reuters indicated that 4,452,438 days of care
were provided to patients in those hospitals during 2009, which represents an average annual
occupancy rate of 59.08 percent. These numbers exclude beds in service for substance abuse,
psychiatry, rehabilitation, hospice, and long-term care. In addition, across the state acute care
bed capacity is expected to increase in certain markets by 619 pending beds and to decrease in
other markets by 323 beds, for a net increase of 296 beds.
It is important to note that not all licensed beds were in service throughout the year.
Some beds were permanently idled, while others were temporarily taken out of service due to
staff shortages or to accommodate renovation projects.
Changes from the Previous Plan
Substantive changes to the Acute Care Bed Need Methodology have been incorporated
into the North Carolina 2011 State Medical Facilities Plan. The changes are summarized below:
1. The definition of Acute Care Bed Service Area was changed from the
definition shown below:
“The Acute Care Bed Service Area is a single county, except where there
is no hospital located within the county in which case the county or
counties without a hospital are combined in a multicounty grouping with a
county that has a hospital. Multicounty groupings are determined based
on the county in which the hospital or hospitals that provide the largest
number of inpatient days of care to the residents of the county which has
no hospital, except as described in the following sentences. In response to
a petition submitted to the State Health Coordinating Council, Hoke
County was assigned to Moore and Cumberland counties for the North
Carolina 2010 State Medical Facilities Plan. This created a Cumberland
Hoke Multicounty Acute Care Bed Service Area, in addition to the
existing Moore Hoke Multicounty Acute Care Bed Service Area. Data to
determine patient’s county of residence (based on the Thomson Reuters
data) that is used to establish the multicounty groupings were provided by
the Sheps Center. (Note: An acute care bed’s service area is the acute
care bed planning area in which the bed is located. The acute care bed
planning areas are the single and multicounty groupings shown in Figure
5.1.)” (North Carolina 2010 State Medical Facilities Plan, pages 44-45)
The revised Acute Care Bed Service Area definition is shown in
Application of the Methodology, Step 1.
2. Additionally, the Acute Care Bed Need Methodology assumptions used in
Table 5A were changed. The previous assumptions and the revised
assumptions are described in the table below:
Assumption Previous Revised
Data Source for Growth Rate Includes all days from N.C.
residents in N.C. acute care
hospitals.
Excludes all days from out-of-state
residents in N.C. acute care
hospitals.
Excludes days from psychiatric,
substance abuse and
rehabilitation hospitals.
Excludes outliers.
Includes acute care days only.
Excludes psychiatric, substance
abuse and rehabilitation days.
Includes outliers and non-N.C.
resident days.
Historical Patient Day Growth Uses four years of data and three
years of trend.
Uses five years of data and four
years of trend.
Number of Projection Years Six Four
Calculation Method for Growth
Rate Factors
Uses a statewide average growth
rate.
Uses a county-specific growth
rate without aggregating
counties with small hospitals.
Target Occupancy Rates
ADC 1-99
ADC 100-200
ADC>200 and <=400
ADC>400:
66.7%
71.4%
75.2%
75.2%
66.7%
71.4%
75.2%
78.0%
The revised Acute Care Bed Need assumptions from the above table were incorporated
into Table 5A of the North Carolina 2011 State Medical Facilities Plan.
The inventory has been updated and references to dates have been advanced by one year
as appropriate.
Basic Principles
A. Acute Care Hospital Goals
1. To facilitate continuing improvement in the state’s acute care
services. Advances in medical practice frequently entail the development
of new services, new facilities or both. The policy of the state is to
encourage their development when cost effective and essential to assure
reasonable accessibility to services.
2. To expand the availability of appropriate, adequate acute care service
to the people of North Carolina. Our improving highways and
transportation systems have brought acute care services within reasonable
geographic reach of all North Carolinians, but not within financial reach.
Despite the expansion of the state’s Medicaid Program, in 2004 17.5
percent of North Carolinians under the age of 65 were uninsured for a full
year, according to a study by the Cecil G. Sheps Center for Health
Services Research, at the University of North Carolina at Chapel Hill.
3. To protect the resource that the state’s acute care hospitals represent.
The acute care hospitals are the providers of essential health care services,
the state’s third largest employer, the largest single investment of public
funds in many communities, magnets for physicians deciding where to
practice, and building blocks in the economic development of their
communities. North Carolina must safeguard the future of its hospitals.
Even so, it is not the state’s policy to guarantee the survival and continued
operation of all the state’s hospitals, or even any one of them. In a
dynamic, fast-changing environment, which is moving away from
inpatient hospital services, the survival and future activities of hospitals
will be a function of many factors beyond the realm of state policy.
The state can, however, facilitate the survival of its hospitals and promote
the development of needed health care services, acute and non-acute, by
encouraging hospitals to convert unused acute care inpatient facilities to
new purposes, to collaborate with other health care providers, and to
develop health care delivery networks.
4. To encourage the substitution of less expensive for more expensive
services whenever feasible and appropriate. The state supports
continued and expanded use of programs which have demonstrated their
capacity to reduce both the number and length of hospital admissions,
including:
a. Development of health care delivery networks;
b. Increased use of ambulatory surgery;
c. Outpatient diagnostic studies;
d. Preadmission testing;
e. Preadmission certification;
f. Programs to reduce admission and readmission rates;
g. Timely scheduling of admissions;
h. Effective utilization review;
i. Discharge planning;
j. Appropriate use of alternative services such as home health
services, hospice, adult care homes, nursing homes; and
k. Initiating new, or maximizing existing, preventive health services.
5. To assure that substantial capital expenditures for the construction or
renovation of health care facilities are based on demonstrated need.
6. To assure that applicants proposing to expand or replace acute care
beds should provide careful analysis of what they have done to
promote cost-effective alternatives to inpatient care and to reduce
average length of stay.
B. Use of Swing Beds
The North Carolina Department of Health and Human Services supports the use of
"swing beds" in providing long-term nursing care services in rural acute care hospitals.
Section 1883 of the Social Security Act provides that certain small rural hospitals may
use their inpatient facilities to furnish skilled nursing facility (SNF) services to Medicare and
Medicaid beneficiaries and intermediate care facility (ICF) services to Medicaid beneficiaries.
Hospitals wishing to receive swing bed certification for Medicare patients must meet the
eligibility criteria outlined in the law which include:
1. Have a certificate of need, or a letter from the Certificate of Need Section
indicating that no certificate of need review is required to provide "swing
bed" services; and
2. Have a current valid Medicare provider agreement; and
3. Be located in an area of the state not designated as "urbanized" by the
most recent official census; and
4. Have fewer than 100 hospital beds, excluding beds for newborns and beds
in intensive type inpatient units; and
5. Not have in effect a 24-hour nursing waiver granted under 42 CFR
488.54(c); and
6. Not have had a swing bed approval terminated within the two years
previous to application; and
7. Meet the Swing Bed Conditions of Participation (see 42 CFR 482.66) on
Resident Rights; Admission, Transfer, and Discharge Rights; Resident
Behavior and Facility Practices; Patient Activities; Social Services;
Discharge Planning; Specialized Rehabilitative Services; and Dental
Services.
A certificate of need is not required if capital expenditures associated with the swing bed service
do not exceed $2 million, and there is no change in bed capacity.
Sources of Data
Inventory of Acute Care Beds:
The inventory of hospital facilities is maintained through the hospitals' response to a state
law that requires each facility to notify the North Carolina Department of Health and
Human Services and receive appropriate approvals before construction, alterations or
additions to existing buildings or any changes in bed capacities. Bed counts are revised
in the state's inventory as changes are reported and approved.
Days of Care and Patient Origin Data for the Bed Need Methodology:
The data source for annual days of care used in the methodology is Thomson Reuters, a
collector of hospital patient discharge information. The general acute care days of care
by facility and data on patients’ county of residence were provided by the Sheps Center
based on the Thomson Reuters data. (Note: The determination of whether a patient
record was categorized as an “acute care/general discharge” was determined by the
revenue code(s) for accommodation type, as submitted to Thomson Reuters by facilities
on the UB-92 form. Included in Column F, "Thomson 2009 Acute Care Days" are
records with revenue codes signifying an acute care/general accommodation type.
Likewise, any records that are coded as substance abuse, psychiatric, or rehabilitation
discharges are excluded from these figures.)
Basic Assumptions of the Methodology
 Target occupancies of hospitals should encourage efficiency of operation,
and vary with average daily census:
Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
ADC 1-99 66.7%
ADC 100-200 71.4%
ADC>200 and <=400 75.2%
ADC>400: 78.0%
 In determining utilization rates and average daily census, only acute care
bed “days of care” are counted.
 If a hospital has received approval to increase or decrease acute care bed
capacity, this change is incorporated into the anticipated bed capacity
regardless of the licensure status of the beds.
Application of the Methodology
Step 1
Counties that have at least one licensed acute care hospital are Single County Acute Care
Bed Service Areas unless the county is grouped with a county lacking a licensed acute care
hospital. When a county that has at least one licensed acute care hospital is grouped with a
county lacking a licensed acute care hospital, a Multicounty Acute Care Bed Service Area is
created.
All counties lacking a licensed acute care hospital are grouped with either one or two
counties that each have at least one licensed acute care hospital. A Multicounty Acute Care Bed
Service Area may consist of multiple counties lacking a licensed acute care hospital that are
grouped with either one or two counties that each have at least one licensed acute care hospital.
The three most recent years of available acute care days patient origin data are combined
and used to create the Multicounty Acute Care Bed Service Areas. These data are updated and
reviewed every three years. The Multicounty Acute Care Bed Service Areas are then updated, as
indicated by the data. The first update occurred in the North Carolina 2011 State Medical
Facilities Plan. The following decision rules are used to determine multicounty acute care bed
service area groupings.
1. Counties lacking a licensed acute care hospital are grouped with the single
county where the largest proportion of patients received inpatient acute
care services, as measured by acute inpatient days, unless;
a. Two counties with licensed acute care hospitals each provided
inpatient acute care services to at least 35 percent of the residents
who received inpatient acute care services, as measured by acute
inpatient days.
2. If 1 a. is true, then the county lacking a licensed acute care hospital is
grouped with both the counties which provided inpatient acute care
services to at least 35 percent of the residents who received inpatient acute
care services, as measured by acute inpatient days.
A county lacking a licensed acute care hospital becomes a Single County Acute Care Bed
Service Area upon licensure of an acute care hospital in that county. If a certificate of need is
issued for development of an acute care hospital in a county lacking an acute care hospital, the
acute care beds for which the certificate of need has been issued will be included in the inventory
of beds in that county’s multicounty acute care bed service area until those beds are licensed.
An acute care bed’s service area is the acute care bed planning area in which the bed is
located. The acute care bed planning areas are the single and multicounty groupings shown in
Figure 5.1.
Step 2 (Columns D and E)
Determine the number of acute care beds in the inventory by totaling:
(Column D)
a. the number of licensed acute care beds at each hospital;
(Column E)
b. the number of acute care beds for which certificates of need have been
issued, but for which changes in the license have not yet been made (i.e.,
additions, reductions, and relocations); and
c. the number of acute care beds for which a need determination in the North
Carolina State Medical Facilities Plan is pending review or appeal.
Step 3 (Column F)
Determine the total number of acute inpatient days of care provided by each hospital
based on the data contained in the above referenced report for Federal Fiscal Year 2009. (Please
see note in “Sources of Data” regarding identification of general acute days of care.)
Step 4 (Columns G and H)
Calculate the projected inpatient days of care in Federal Fiscal Year 2013 as follows:
a. For each county, determine the total annual number of acute inpatient days
of care provided in North Carolina acute care hospitals during each of the
last five federal fiscal years based on data provided by the Sheps Center.
b. For each county, calculate the difference in the number of acute inpatient
days of care provided from year to year.
c. For each county, for each of the last four years, determine the percentage
change from the previous year by dividing the calculated difference in
acute inpatient days by the total number of acute inpatient days provided
during the previous year. (Example: (YR 2009 – YR 2008) / YR 2009; etc.)
(Column G)
d. For each county, total the annual percentages of change and divide by four
to determine the average annual historical percentage change for each
county. For positive annual percentages of change, add 1 and this
becomes the County Growth Rate Multiplier. For negative annual
percentages of change, subtract 1. If the County Growth Rate Multiplier
is negative, Thomson Reuters 2009 Acute Care Days are carried forward
unchanged to Column H.
e. For each county with a positive County Growth Rate Multiplier, calculate
the compounded growth factor projected for the next four years by using
the average annual historical percentage change (from d. above) in the
first year and compounding the change each year thereafter at the same
rate.
(Column H)
f. For each hospital, multiply the acute inpatient days of care from Column F
by the compounded county growth factor to project the number of acute
inpatient days of care to be provided in Federal Fiscal Year 2013 at each
hospital.
Step 5 (Column I)
Calculate the projected midnight average daily census for each hospital in Federal Fiscal
Year 2013, by dividing the projected number of acute inpatient days of care provided at the
hospital (from Column H) by 365 days.
Step 6 (Column J)
Multiply each hospital's projected midnight average daily census from Step 5 (Column I)
by the appropriate target occupancy factor below:
Average Daily Census Occupancy Factor
Average Daily Census less than 100 1.50
Average Daily Census 100-200 1.40
Average Daily Census greater than 200 and <=400 1.33
Average Daily Census greater than 400 1.28
Step 7 (Column K)
Determine the surplus or deficit of beds for each hospital by subtracting the inventory of
beds in Step 2 (Column D plus Column E) from the number of beds generated in Step 6 (Column
J). (Note: Deficits will appear as positive numbers; surpluses, as negative numbers.)
Step 8 (Column L)
The number of acute care beds needed in a service area is determined as follows:
a. If two or more hospitals in the same service area are under common
ownership, total the surpluses and deficits of beds for those hospitals to
determine the surplus or deficit of beds for each owner of multiple
hospitals in the service area.
b. When the deficit of total acute care beds in the service area for an owner,
regardless of number of hospitals owned, equals or exceeds 20 beds or 10
percent of the inventory of acute care beds for that owner, the deficits of
all owners in the service area will be summed to determine the number of
acute care beds needed in the service area.
Qualified Applicants
Any qualified applicant may apply for a certificate of need to acquire the needed acute
care beds. A person is a qualified applicant if he or she proposes to operate the additional acute
care beds in a hospital that will provide:
1. a 24-hour emergency services department,
2. inpatient medical services to both surgical and non-surgical patients, and
3. if proposing a new licensed hospital, medical and surgical services on a daily
basis within at least five of the major diagnostic categories as recognized by the
Centers for Medicare and Medicaid Services (CMS), as follows:
MDC 1: Diseases and disorders of the nervous system
MDC 2: Diseases and disorders of the eye
MDC 3: Diseases and disorders of the ear, nose, mouth and throat
MDC 4: Diseases and disorders of the respiratory system
MDC 5: Diseases and disorders of the circulatory system
MDC 6: Diseases and disorders of the digestive system
MDC 7: Diseases and disorders of the hepatobiliary system and
pancreas
MDC 8: Diseases and disorders of the musculoskeletal system and
connective tissue
MDC 9: Diseases and disorders of the skin, subcutaneous tissue and
breast
MDC 10: Endocrine, nutritional and metabolic diseases and disorders
MDC 11: Diseases and disorders of the kidney and urinary tract
MDC 12: Diseases and disorders of the male reproductive system
MDC 13: Diseases and disorders of the female reproductive system
MDC 14: Pregnancy, childbirth and the puerperium
MDC 15: Newborns/other neonates with conditions originating in the
perinatal period
MDC 16: Diseases and disorders of the blood and blood-forming
organs and immunological disorders
MDC 17: Myeloproliferative diseases and disorders and poorly
differentiated neoplasms
MDC 18: Infectious and parasitic diseases
MDC 19: Mental diseases and disorders
MDC 20: Alcohol/drug use and alcohol/drug-induced organic mental
disorders
MDC 21: Injury, poisoning and toxic effects of drugs
MDC 22: Burns
MDC 23: Factors influencing health status and other contacts with
health services
MDC 24: Multiple significant trauma
MDC 25: Human immunodeficiency virus infections
CHEROKEE
SWAIN
JACKSON
GRAHAM
CHATHAM
POLK
BUNCOMBE
MADISON
ASHE
WATAUGA WILKES YADKIN
DAVIE
ROWAN
STOKES
FORSYTH
GUILFORD
ROCKINGHAM
CASWELL
RANDOLPH
DAVIDSON
COLUMBUS
ONSLOW
MOORE
HOKE
LEE
HARNETT
SCOTLAND
BLADEN
SAMPSON DUPLIN
WILSON
WAYNE
LENOIR
GREENE
CARTERET
UNION ANSON
CABARRUS
STANLY
RICHMOND
CRAVEN
JONES
PITT BEAUFORT
WASHINGTON
TYRRELL
DARE
MARTIN
EDGECOMBE
BERTIE
GATES NORTHAMPTON
HERTFORD
WARREN
FRANKLIN
WAKE
PERSON
VANCE
MCDOWELL BURKE
CALDWELL
MITCHELL
YANCEY
LINCOLN
GASTON
RUTHERFORD
CLEVELAND
MACON
CLAY
TRANSYLV ANIA
AVERY
CATAWBA
HYDE
BRUNSWICK
MONTGOMERY
ALEXANDER
ALLEGHANY
HENDERSON
CURRITUCK
PASQUOTANK
PERQUIM.
CAMDEN
CHOWAN
PAMLICO
NEW
HANOVER
SURRY
IREDELL
HAYWOOD
GRANVILLE
HALIFAX
NASH
JOHNSTON
DURHAM
ORANGE
ALAMANCE
CUMBERLAND
ROBESON
PENDER
MECKLENBURG
MOORE
HOKE
HOKE
CUMBERLAND
JACKSON
AHAM GR GRAHAM
BEAUFOR
HYDE
T
GATES
HERTFORD
PITT
HYDE
BUNCOMBE
GATES
PASQUOTANK
Figure 5.1: Acute Care Bed Service Areas
Shaded counties are multi-county acute care bed service areas, consisting of a county with one or more hospitals and a
nearby county or counties without an acute care hospital. County with Hospital
Hospital Multi-County Service Area Color Code
Duke University Hospital, Durham Regional Hospital, North Carolina Specialty Hospital Durham, Caswell
Murphy Medical Center Cherokee, Clay
Mission Hospitals Buncombe, Graham, Madison, Yancey
Harris Regional Hospital Jackson, Graham
First Health Moore Regional Moore, Hoke
Cape Fear Valley Medical Center Cumberland, Hoke
Maria Parham Hospital Vance, Warren
Our Community Hospital and Halifax Regional Medical Center Halifax, Northampton
Pitt County Memorial Hospital Pitt, Greene, Hyde
Craven Regional Medical Center Craven, Jones, Pamlico
Pungo District Hospital and Beaufort County Hospital Beaufort, Hyde
Roanoke-Chowan Hospital Hertford, Gates
Chowan Hospital Chowan, Tyrrell
Albemarle Hospital Pasquotank, Camden, Currituck, Gates, Perquimans
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
H0272
Alamance Regional Medical
Center Alamance 182 0 42,620 1.0027 43,088 118 165 -17 0
H0274 Alexander Hospital Alexander 25 0 0 0 0 0 -25 0
H0108 Alleghany Memorial Hospital Alleghany 41 0 2,316 -1.0816 2,316 6 10 -31 0
H0082 Anson Community Hospital Anson 52 0 4,088 -1.0966 4,088 11 17 -35 0
H0099 Ashe Memorial Hospital Ashe 76 0 4,814 -1.0256 4,814 13 20 -56 0
H0037
Charles A. Cannon, Jr.
Memorial Hospital Avery 30 0 6,101 -1.0816 6,101 17 25 -5 0
H0268 Bertie Memorial Hospital Bertie 6 0 1,674 1.0760 2,244 6 9 3 3
H0154
Cape Fear Valley - Bladen
County Hospital Bladen 48 0 3,082 -1.1060 3,082 8 13 -35 0
H0036 Mission Hospitals Buncombe 673 9 191,139 1.0287 214,024 586 751 69 69
2011 SMFP Buncombe
Madison Yancy Adjusted Need
Determination
Buncombe Madison
Yancey 51
H0031
Carolinas Medical Center -
NorthEast Cabarrus 447 0 101,362 1.0288 113,533 311 414 -33 0
H0061 Caldwell Memorial Hospital Caldwell 110 0 18,446 1.0520 22,591 62 93 -17 0
H0222 Carteret General Hospital Carteret 135 0 25,847 -1.0321 25,847 71 106 -29 0
H0007 Chatham Hospital Chatham 25 0 3,309 1.0772 4,455 12 18 -7 0
Note: Chatham Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
H0239 Murphy Medical Center Cherokee 57 0 9,615 1.0306 10,849 30 45 -12 0
H0063 Chowan Hospital Chowan 49 0 6,819 -1.0050 6,819 19 28 -21 0
H0045 Columbus County Hospital Columbus 154 0 22,091 -1.0406 22,091 61 91 -63 0
H0201 CarolinaEast Medical Canter Craven 307 0 68,398 -1.0300 68,398 187 262 -45 0
H0213
Cape Fear Valley Medical
Center Cumberland 490 41 150,096 1.0315 169,913 466 596 65 65
H0273 The Outer Banks Hospital Dare 21 0 3,162 3,162 9 13 -8 0
H0171 Davie County Hospital Davie 81 -31 831 -1.0243 831 2 3 -47 0
H0166 Duplin General Hospital Duplin 56 0 8,463 -1.0651 8,463 23 35 -21 0
H0258 Heritage Hospital Edgecombe 101 0 14,399 1.0228 15,759 43 65 -36 0
H0261
Franklin Regional Medical
Center Franklin 70 0 6,130 -1.1457 6,130 17 25 -45 0
Counties with one hospital shown first, followed by counties with more than one hospital.
In response to a petition, the need determination for the Buncombe Madison Yancy service area was adjusted to 51 from 69
acute care beds.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0105 Gaston Memorial Hospital Gaston 372 0 79,067 -1.0390 79,067 217 288 -84 0
H0098 Granville Medical Center Granville 62 0 7,963 1.0071 8,193 22 34 -28 0
H0025
Haywood Regional Medical
Center Haywood 153 0 17,623 -1.0249 17,623 48 72 -81 0
H0001 Roanoke-Chowan Hospital Hertford 86 0 14,058 -1.0503 14,058 39 58 -28 0
H0087 Harris Regional Hospital Jackson 86 0 14,987 -1.0354 14,987 41 62 -24 0
H0151 Johnston Memorial Hospital Johnston 157 22 34,709 -1.0120 34,709 95 143 -36 0
H0243 Central Carolina Hospital Lee 127 0 20,832 1.0178 22,352 61 92 -35 0
H0043 Lenoir Memorial Hospital Lenoir 218 0 42,389 -1.0289 42,389 116 163 -55 0
H0225
Carolinas Medical Center -
Lincoln Lincoln 101 0 15,881 1.0227 17,371 48 71 -30 0
H0078 Martin General Hospital Martin 49 0 8,115 1.0156 8,634 24 35 -14 0
H0097 The McDowell Hospital McDowell 65 0 5,745 -1.0903 5,745 16 24 -41 0
H0169 Blue Ridge Regional Hospital Mitchell 46 0 6,744 1.0038 6,847 19 28 -18 0
H0003
FirstHealth Montgomery
Memorial Hospital Montgomery 37 0 1,357 -1.1126 1,357 4 6 -31 0
H0100
FirstHealth Moore Regional
Hospital Moore 297 23 78,996 1.0124 82,977 227 302 -18 0
H0228 Nash General Hospital Nash 270 0 50,978 -1.0392 50,978 140 196 -74 0
H0221
New Hanover Regional Medical
Center New Hanover 647 0 148,223 -1.0117 148,223 406 520 -127 0
H0048 Onslow Memorial Hospital Onslow 162 0 30,250 -1.0053 30,250 83 124 -38 0
H0157
University of North Carolina
Hospitals Orange 678 51 188,516 1.0249 207,978 570 729 0 0
H0054 Albemarle Hospital Pasquotank 182 0 23,942 -1.0985 23,942 66 98 -84 0
H0115 Pender Memorial Hospital Pender 43 0 2,639 -1.1146 2,639 7 11 -32 0
H0066 Person Memorial Hospital Person 50 0 9,093 -1.0322 9,093 25 37 -13 0
H0104 Pitt County Memorial Hospital Pitt 734 0 204,768 1.0217 223,117 611 782 48 48
H0079 St. Luke's Hospital Polk 45 0 3,817 -1.0454 3,817 10 16 -29 0
H0013 Randolph Hospital Randolph 145 0 27,065 1.0343 30,979 85 127 -18 0
H0064
Southeastern Regional Medical
Center Robeson 292 0 57,851 -1.0399 57,851 158 222 -70 0
H0040
Rowan Regional Medical
Center Rowan 223 0 34,188 -1.0195 34,188 94 140 -83 0
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0039 Rutherford Hospital Rutherford 129 0 18,059 1.0007 18,110 50 74 -55 0
H0067
Sampson Regional Medical
Center Sampson 116 0 11,160 -1.0881 11,160 31 46 -70 0
H0107 Scotland Memorial Hospital Scotland 97 21 23,251 -1.0306 23,251 64 96 -22 0
H0008 Stanly Regional Medical Center Stanly 97 0 13,600 -1.0740 13,600 37 56 -41 0
H0165
Stokes-Reynolds Memorial
Hospital Stokes 53 0 732 -1.1784 732 2 3 -50 0
H0069 Swain County Hospital Swain 48 0 1,550 -1.0348 1,550 4 6 -42 0
H0111
Transylvania Community
Hospital Transylvania 42 0 5,646 -1.0098 5,646 15 23 -19 0
H0050
Carolinas Medical Center -
Union Union 157 0 39,847 1.0658 51,419 141 197 15 0
2010 SMFP Union County Adjusted Need Determination
2010 SMFP Union County
Adjusted Need Determination Union 25 0 1.0658 0 0
Union Total 157 25 0
H0267 Maria Parham Hospital Vance 91 0 18,367 -1.0270 18,367 50 75 -16 0
H0006 Washington County Hospital Washington 49 -37 1,855 -1.0801 1,855 5 8 -4 0
Note: Washington County Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
H0257 Wayne Memorial Hospital Wayne 255 0 58,855 -1.0056 58,855 161 226 -29 0
H0153 Wilkes Regional Medical Center Wilkes 120 0 15,339 -1.0789 15,339 42 63 -57 0
H0210 Wilson Medical Center Wilson 271 -73 33,422 -1.0079 33,422 92 137 -61 0
H0155
Yadkin Valley Community
Hospital (prev. Hoots Memorial
Hospital) Yadkin 22 0 792 -1.0224 792 2 3 -19 0
Note: Yadkin Valley Community Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0188 Beaufort County Hospital Beaufort 120 0 10,282 -1.0949 10,282 28 42 -78
H0002
Pungo District Hospital
Corporation Beaufort 39 0 1,955 -1.0949 1,955 5 8 -31
Beaufort Total 159 0 0
H0250 Brunswick Community Hospital Brunswick 60 14 11,305 -1.0133 11,305 31 46 -28
H0150
J. Arthur Dosher Memorial
Hospital Brunswick 36 0 4,363 -1.0133 4,363 12 18 -18
Brunswick Total 96 14 0
H0062 Grace Hospital Burke 162 0 20,473 -1.0310 20,473 56 84 -78
H0091 Valdese General Hospital Burke 131 0 10,436 -1.0310 10,436 29 43 -88
Burke Total 293 0 0
H0223 Catawba Valley Medical Center Catawba 200 0 36,473 -1.0173 36,473 100 150 -50
H0053 Frye Regional Medical Center Catawba 209 0 46,820 -1.0173 46,820 128 180 -29
Catawba Total 409 0 0
H0024
Cleveland Regional Medical
Center Cleveland 241 0 33,492 -1.0637 33,492 92 138 -103
H0113 Kings Mountain Hospital Cleveland 72 0 7,210 -1.0637 7,210 20 30 -42
Cleveland Total 313 0 0
H0027 Lexington Memorial Hospital Davidson 94 0 10,808 -1.0673 10,808 30 44 -50
H0112 Thomasville Medical Center Davidson 123 -10 10,452 -1.0673 10,452 29 43 -70
Davidson Total 217 -10 0
H0015 Duke University Hospital Durham 924 0 244,688 1.0116 256,260 702 899 -25
(Duke University Hospital has a CON for 14 additional acute care beds under Policy AC-3. These 14 beds are not counted when determining acute care bed need.)
H0233 Durham Regional Hospital Durham 316 0 64,634 1.0116 67,691 185 260 -56
1,240 0 309,322 323,950 888 1,158 -82
H0075
North Carolina Specialty
Hospital Durham 18 0 3,574 1.0116 3,743 10 15 -3
Durham Total 1,258 0 0
Duke/Durham Regional Hospital Totals
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0209 Forsyth Medical Center Forsyth 784 49 209,634 1.0084 216,757 594 760 -73
H0229 Medical Park Hospital Forsyth 22 -10 3,713 1.0084 3,839 11 16 4
806 39 213,347 220,596 604 776 -69
H0011 North Carolina Baptist Hospitals Forsyth 802 0 205,527 1.0084 212,510 582 745 -57
Forsyth Total 1,608 39 0
H0052
High Point Regional He

NORTH CAROLINA
2011 STATE MEDICAL FACILITIES PLAN
Effective January 1, 2011
Prepared by the
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Medical Facilities Planning Section
Under the direction of the
North Carolina State Health Coordinating Council
For information contact the
North Carolina Division of Health Service Regulation
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
http://www.ncdhhs.gov/dhsr/ncsmfp/index.html
(919) 855 - 3865 Telephone Number
(919) 715 - 4413 FAX Number
The North Carolina Department of Health and Human Services does not
discriminate on the basis of race, color, national origin, sex, religion, age
or disability in employment or the provision of services.
TABLE OF CONTENTS
Background
Chapter 1 Overview of the North Carolina 2011 State Medical Facilities Plan 1
Chapter 2 Amendments and Revisions 9
Chapter 3 Certificate of Need Review Categories and Schedule 19
Chapter 4 Statement of Policies: 23
Acute Care Hospitals 23
Nursing Care Facilities 26
Adult Care Homes 32
Home Health Services 34
End-Stage Renal Disease Dialysis Services 34
Mental Health, Developmental Disabilities, and 35
Substance Abuse (General)
Psychiatric Inpatient Services 35
Intermediate Care Facilities for the Mentally Retarded 35
All Health Services 36
Acute Care Facilities and Services
Chapter 5 Acute Care Hospital Beds 43
Chapter 6 Operating Rooms 63
Chapter 7 Other Acute Care Services 99
Open Heart Surgery Services and 99
Heart-Lung Bypass Machines
Burn Intensive Care Services 104
Transplantation Services 106
Chapter 8 Inpatient Rehabilitation Services 111
Technology and Equipment
Chapter 9 Technology 117
Lithotripsy 118
Gamma Knife 126
Linear Accelerators 127
Positron Emission Tomography Scanner 141
Magnetic Resonance Imaging 147
Cardiac Catheterization Equipment 183
Long-Term Care Facilities and Services
Chapter 10 Nursing Care Facilities 199
Chapter 11 Adult Care Homes 219
Chapter 12 Home Health Services 247
Chapter 13 Hospice Services 303
Chapter 14 End-Stage Renal Disease Dialysis Facilities 347
Chapter 15 Psychiatric Inpatient Services 355
Chapter 16 Substance Abuse Inpatient And Residential Services 367
(Chemical Dependency Treatment Beds)
Chapter 17 Intermediate Care Facilities for the Mentally Retarded 377
Appendices
Appendix A: North Carolina Counties by Health Service Areas 391
Appendix B: Partial Listing of Health Planning Acronyms 393
Appendix C: List of Contiguous Counties 395
Appendix D: North Carolina Certificate of Need Statute 399
Appendix E: Regulation of Detoxification Services Provided in 421
Hospitals Licensed under Article 5, Chapter 131E,
of the General Statutes
DISCLAIMER
The North Carolina 2011 State Medical Facilities Plan is subject to revision throughout the year.
Notices containing updates and changes will be posted on the North Carolina Division of Health
Service Regulation web page at http://www.ncdhhs.gov/dhsr/ncsmfp/index.html as they are
approved. Check our web site periodically for updates.
Chapter 1:
Overview of the 2011 State Medical Facilities Plan
CHAPTER 1
OVERVIEW OF THE NORTH CAROLINA 2011 STATE MEDICAL FACILITIES
PLAN
Purpose
The North Carolina 2011 State Medical Facilities Plan (“Plan”) was developed by the
North Carolina Department of Health and Human Services, Division of Health Service
Regulation, under the direction of the North Carolina State Health Coordinating Council,
(SHCC) pursuant to G.S. §131E-177. The major objective of the Plan is to provide individuals,
institutions, state and local government agencies, and community leadership with policies and
projections of need to guide local planning for specific health care facilities and services.
Projections of need are provided for the following types of facilities and services:
 acute care hospitals
 operating rooms
 inpatient rehabilitation facilities
 technology services
 nursing care facilities
 adult care facilities
 Medicare-certified home health agencies
 end-stage renal disease dialysis facilities
 hospice home care and hospice inpatient beds
 psychiatric hospital units and specialty hospitals
 substance abuse hospital units, specialty hospitals,
and residential facilities
 intermediate care facilities for people with mental retardation
Chapters dealing with specific facility/service categories contain summaries of the supply
and the utilization of each type of facility or service, a description of changes in the projection
method and policies from the previous planning year, a description of the projection method, and
other data relevant to the projections of need.
The projections of need for the various facilities and services are used in conjunction with
other statutes and rules in reviewing certificate of need applications for establishment, expansion,
or conversion of health care facilities and services. All parties interested in health care facility
and health services planning should consider this Plan a key resource.
Basic Principles Governing the Development of this Plan
1. Safety and Quality Basic Principle
The State of North Carolina recognizes the importance of systematic and ongoing
improvement in the quality of health services. Citizens of North Carolina rightfully expect
health services to be safe and efficient. To warrant public trust in the regulation of health
services, monitoring of safety and quality using established and independently verifiable metrics
will be an integral part of the formulation and application of the North Carolina State Medical
Facilities Plan.
Scientific quantification of quality and safety is rapidly evolving. Emerging measures of
quality address both favorable clinical outcomes and patient satisfaction, while safety measures
focus on the elimination of practices that contribute to avoidable injury or death and the adoption
of practices that promote and ensure safety. The SHCC recognizes that while safety, clinical
outcomes, and satisfaction may be conceptually separable, they are often interconnected in
practice. The North Carolina State Medical Facilities Plan should maximize all three elements.
Where practicalities require balancing of these elements, priority should be given to safety,
followed by clinical outcomes, followed by satisfaction.
The appropriate measures for quality and safety should be specific to the type of facility
or service regulated. Clinical outcome and safety measures should be evidence-based and
objective. Patient satisfaction measures should be quantifiable. In all cases, metrics should be
standardized and widely reported and preference should be given to those metrics reported on a
national level. The SHCC recognizes that metrics meeting these criteria are currently better
established for some services than for others. Furthermore, experience and research as well as
regulation at the federal level will continue to identify new measures that may be incorporated
into the standards applicable to quality and safety. As experience with the application of quality
and safety metrics grows, the SHCC should regularly review policies and need methodologies
and revise them as needed to address any persistent and significant deficiencies of safety and
quality in a particular service area.
2. Access Basic Principle
Equitable access to timely, clinically appropriate and high quality health care for all the
people of North Carolina is a foundational principle for the formulation and application of the
North Carolina State Medical Facilities Plan. Barriers to access include, but are not limited to:
geography, low income, limited or no insurance coverage, disability, age, race, ethnicity, culture,
language, education and health literacy. Individuals whose access to needed health services is
impeded by any of these barriers are medically underserved. The formulation and
implementation of the North Carolina State Medical Facilities Plan seeks to reduce all of these
types of barriers to timely and appropriate access. The first priority is to ameliorate economic
barriers and the second priority is to mitigate time and distance barriers.
The impact of economic barriers is twofold. First, individuals without insurance, with
insufficient insurance, or without sufficient funds to purchase their own health care will often
require public funding to support access to regulated services. Second, the preferential selection
by providers of well funded patients may undermine the advantages that can accrue to the public
from market competition in health care. A competitive marketplace should favor providers that
deliver the highest quality and best value care, but only in the circumstance that all competitors
deliver like services to similar populations.
The SHCC assigns the highest priority to a methodology that favors providers delivering
services to a patient population representative of all payer types in need of those services in the
service area. Comparisons of value and quality are most likely to be valid when services are
provided to like populations. Incentives for quality and process improvement, resource
maximization, and innovation are most effective when providers deliver services to a similar and
representative mixture of patients.
Access barriers of time and distance are especially critical to rural areas and small
communities. However, urban populations can experience similar access barriers. The SHCC
recognizes that some essential, but unprofitable, medical services may require support by
revenues gained from profitable services or other sources. The SHCC also recognizes a trend to
the delivery of some services in more accessible, less complex, and less costly settings.
Whenever verifiable data for outcome, satisfaction, safety, and costs for the delivery of such
services to representative patient populations justify, the SHCC will balance the advantages of
such ambulatory facilities with the needs for financial support of medically necessary but
unprofitable care.
The needs of rural and small communities that are distant from comprehensive urban
medical facilities merit special consideration. In rural and small communities selective
competition that disproportionately captures profitable services may threaten the viability of sole
providers of comprehensive care and emergency services. For this reason methodologies that
balance value, quality and access in urban and rural areas may differ quantitatively. The SHCC
planning process will promote access to an appropriate spectrum of health services at a local
level, whenever feasible under prevailing quality and value standards.
3. Value Basic Principle
The SHCC defines health care value as maximum health care benefit per dollar
expended. Disparity between demand growth and funding constraints for health care services
increases the need for affordability and value in health services. Maximizing the health benefit
for the entire population of North Carolina that is achieved by expenditures for services regulated
by the State Medical Facilities Plan will be a key principle in the formulation and
implementation of SHCC recommendations for the State Medical Facilities Plan.
Measurement of the cost component of the value equation is often easier than
measurement of benefit. Cost per unit of service is an appropriate metric when comparing
providers of like services for like populations. The cost basis for some providers may be inflated
by disproportionate care to indigent and underfunded patients. In such cases the SHCC
encourages the adjustment of cost measures to reflect such disparity, but only to the extent such
expenditures can be measured according to an established, state-wide standard that is uniformly
reported and verifiable. Measurement of benefit is more challenging. Standardized safety and
quality measures, when available, can be important factors in achieving improved value in the
provision of health services. Prevention, early detection and early intervention are important
means for increasing the total population benefit for health expenditures. Development of new
technology has the potential to add value by improving outcome and enhancing early detection.
Capital costs of such new technology may be greater but justified by the added population
benefit. At the same time overutilization of more costly and/or highly specialized, low-volume
services without evidence-based medical indications may contribute to escalating health costs
without commensurate population-based health benefit. The SHCC favors methodologies which
encourage technological advances for proven and affordable benefit and appropriate utilization
for evidence-based indications when available. The SHCC also recognizes the importance of
primary care and health education in promoting affordable health care and best utilization of
scarce and expensive health resources. Unfortunately technologically sophisticated and costly
services that benefit small numbers of patients may be more readily pursued than simple and less
costly detection and prevention measures that benefit the broader population. In the pursuit of
maximum population-based health care value, the SHCC recognizes the potential adverse impact
for growth of regulated services to supplant services of broad benefit to the larger population.
Long-term enhancement of health care value will result from a state medical facilities
plan that promotes a balance of competition and collaboration and encourages innovation in
health care delivery. The SHCC encourages the development of value-driven health care by
promoting collaborative efforts to create common resources such as shared health databases,
purchasing cooperatives, and shared information management, and by promoting coordinated
services that reduce duplicative and conflicting care. The SHCC also recognizes the importance
of balanced competition and market advantage in order to encourage innovation, in so far as
those innovations improve safety, quality, access, and value in health care delivery.
The State Health Planning Process
Throughout the development of the North Carolina State Medical Facilities Plan there are
opportunities for public review and comment. Sections of the Plan, including the policies and
methods for projecting need, are developed with the assistance of committees of the North
Carolina State Health Coordinating Council (Table 1A). The committees submit their
recommendations to the Council for approval. A Proposed Plan is assembled and made available
to the public. Public hearings on the Proposed Plan are held throughout the State during the
summer. Comments and petitions received during this period are considered by the Council and,
upon incorporation of all changes approved by the Council, a final draft of the Plan is presented
to the Governor for review and approval. With the Governor’s approval, the State Medical
Facilities Plan becomes the official document for health facility and health service planning in
North Carolina for the specified calendar year.
Other Publications
Information concerning publications or the availability of other data related to the health
planning process may be obtained by contacting the North Carolina Division of Health Service
Regulation, Medical Facilities Planning Section.
North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
Telephone Number: (919) 855-3865
FAX Number: (919) 715-4413
NOTE
Determinations of need for services and facilities in this Plan do not imply an intent on the
part of the North Carolina Department of Health and Human Services, Division of Medical
Assistance to participate in the reimbursement of the cost of care of patients using services
and facilities developed in response to this need.
Table 1A: North Carolina State Health Coordinating Council Members,
Committee Membership, and Staff
Members: Representing: From:
William Wainwright, Chairman N.C. House of Representatives Havelock
Donald Beaver Health Care Facilities Association Hickory
Bill Bedsole At-Large Washington
Greg Beier At-Large Winston-Salem
Don Bradley, MD Health Insurance Industry Durham
Richard Bruch, MD Medical Society Durham
Dennis Clements, III, MD Academic Medical Centers Durham
Lawrence Cutchin, MD At-Large Tarboro
Johnnie Farmer County Commissioners Association Aulander
Senator Anthony Foriest N.C. Senate Graham
Sandra Greene, DrPH At-Large Chapel Hill
Ted Griffin Business and Industry Durham
Harold Hart Business and Industry Siler City
Laurence Hinsdale At-Large Concord
Daniel Hoffmann Veterans Administration Durham
John Holt, Jr., MD At-Large Raleigh
Eric Janis, MD At-Large Smithfield
Brenda Latham-Sadler, MD At-Large Winston-Salem
Leslie Marshall, MD At-Large Raleigh
Frances Mauney At-Large Durham
William McMillan, Jr., MD Area Health Education Centers Wilmington
Zach Miller Long-Term Care Facilities Association Wilmington
Jerry Parks Association of Local Health Directors Edenton
Prashant Patel, MD At-Large Cary
Thomas Pulliam, MD At-Large Winston-Salem
Pam Tidwell Home Care Association Asheville
Christopher Ullrich, MD At-Large Charlotte
Zane Walsh, MD At-Large Fayetteville
John Young Hospital Association Kings Mountain
Committees and Staff Members
Acute Care Services Committee
Planning for acute care beds, operating rooms, open heart surgery services, heart-lung
bypass machines, burn intensive care services, transplantation services [bone marrow transplants
and solid organ transplants], and inpatient rehabilitation services:
Sandra Greene, DrPH, (Chair); Greg Beier, (Vice Chair); Bill Bedsole; Lawrence Cutchin,
MD; Brenda Latham-Sadler, MD; Leslie Marshall, MD; Zane Walsh, MD; John Young
Staffed by: Dr. Carol Potter
Long-Term and Behavioral Health Committee
Planning for nursing care facilities, adult care homes, home health services, hospice
services, end-stage renal disease dialysis facilities, psychiatric inpatient facilities, substance
abuse inpatient and residential services (chemical dependency treatment beds), and intermediate
care facilities for the mentally retarded:
Thomas Pulliam, MD, (Chair); Jerry Parks, (Vice Chair); Donald Beaver; Johnnie Farmer;
Senator Anthony Foriest; Ted Griffin; Zach Miller; Pam Tidwell
Staffed by: Patrick Baker
Technology and Equipment Committee
Planning for lithotripsy, gamma knife, linear accelerators, positron emission tomography
scanners, magnetic resonance imaging scanners, and cardiac catheterization/angioplasty
equipment:
Christopher Ullrich, MD, (Chair); William McMillan, Jr., MD, (Vice Chair); Richard Bruch,
MD; Dennis Clements III, MD; Harold Hart; Laurence Hinsdale; John Holt, MD; Eric Janis,
MD
Staffed by: Dr. Carol Potter
Quality, Access and Value Committee
Quality, Access and Value Committee is charged with: promoting high quality health
care services as measured by outcomes and satisfaction, equitable access to health care services
for all North Carolina’s people, and high value practices that will maximize the health care
benefit gained for resources expended:
Don Bradley, MD, (Chair); Frances Mauney, (Vice Chair); Greg Beier; Daniel Hoffmann;
William McMillan, Jr.; Jerry Parks; Prashant Patel, MD
Staffed by: Patrick Baker
Medical Facilities Planning Section Staff
Elizabeth K. Brown, Chief
Gene DePorter, Assistant Chief, Planner
Patrick Baker, Planner
Carol G. Potter, Planner
Erin Glendening, Technology Support Analyst
Kelli Fisk, Administrative Assistant
Division of Health Service Regulation
Drexdal Pratt, Director
Chapter 2:
Amendments and Revisions
CHAPTER 2
AMENDMENTS AND REVISIONS TO THE STATE MEDICAL FACILITIES PLAN
Amendment of Approved Plans
After the North Carolina State Medical Facilities Plan has been signed by the Governor,
it will be amended only as necessary to correct errors or to respond to statutory changes,
amounts of legislative appropriations or judicial decisions. The North Carolina State Health
Coordinating Council will conduct a public hearing on proposed amendments and will
recommend changes it deems appropriate for the Governor's approval.
NOTE: Need determinations as shown in this document may be increased or decreased during
the year pursuant to Policy GEN-2 (See Chapter 4).
Petitions to Revise the Next State Medical Facilities Plan
Anyone who finds that the North Carolina State Medical Facilities Plan policies or
methodologies, or the results of their application, are inappropriate may petition for changes or
revisions. Such petitions are of two general types: those requesting changes in basic policies and
methodologies, and those requesting adjustments to the need projections.
Petitions for Changes in Basic Policies and Methodologies
People who wish to recommend changes that may have a statewide effect are asked to
contact the Medical Facilities Planning Section staff as early in the year as possible, and to
submit petitions no later than March 2, 2011. Changes with the potential for a statewide effect
are the addition, deletion, and revision of policies or projection methodologies. These types of
changes will need to be considered in the first four months of the calendar year as the "Proposed
North Carolina State Medical Facilities Plan" (explained below) is being developed.
Instructions for Writing Petitions for Changes in Basic Policies and Methodologies
At a minimum, each written petition requesting a change in basic policies and
methodologies used in the North Carolina State Medical Failities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. Statement of the requested change, citing the policy or planning
methodology in the North Carolina State Medical Facilities Plan for which
the change is proposed.
3. Reasons for the proposed change to include:
a. A statement of the adverse effects on the providers or consumers of
health services that are likely to ensue if the change is not made, and
b. A statement of alternatives to the proposed change that were
considered and found not feasible.
4. Evidence that the proposed change would not result in unnecessary
duplication of health resources in the area.
5. Evidence that the requested change is consistent with the three Basic
Principles governing the development of the North Carolina State Medical
Facilities Plan: Safety and Quality, Access, and Value.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the North Carolina Division of Health Service Regulation’s Medical
Facilities Planning Section by 5:00 p.m. on March 2, 2011. Petitions must be submitted by e-mail,
fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
701 Barbour Drive
Raleigh, North Carolina 27603
Response to Petitions for Changes in Basic Policies and Methodologies
The process for response to such petitions is as follows:
1. Staff, in reviewing the proposed change, may request additional
information and opinions from the petitioner or any other
personororganization(s) who may be affected by the proposed change.
2. The petition and other information will be made available to the members
of the appropriate committee of the North Carolina State Health
Coordinating Council.
3. The petition will be considered by the appropriate committee of the North
Carolina State Health Coordinating Council and the committee will make
recommendations to the North Carolina State Health Coordinating Council
regarding disposition of the petition.
4. The North Carolina State Health Coordinating Council will consider the
committee’s recommendations and make decisions regarding whether or
not to incorporate the changes into the final North Carolina State Medical
Facilities Plan.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for changes in basic policies and
methodologies in the North Carolina State Medical Facilities Plan will be made no later than the
final Council meeting of the calender year.
Petitions for Adjustments to Need Determinations
A Proposed North Carolina State Medical Facilities Plan is adopted annually by the
North Carolina State Health Coordinating Council, and is made available for review by
interested parties during an annual "Public Review and Comment Period." During this period,
regional public hearings are held to receive oral/written comments and written petitions. The
Public Review and Comment Period for consideration of each Proposed North Carolina State
Medical Facilities Plan is determined annually and dates are available from the Medical
Facilities Planning Section and published in the North Carolina State Medical Facilities Plan,
People who believe that unique or special attributes of a particular geographic area or
institution give rise to resource requirements that differ from those provided by application of the
standard planning procedures and policies may submit a written petition requesting an
adjustment be made to the need determination given in the Proposed North Carolina State
Medical Facilities Plan. These petitions should be delivered to the Medical Facilities Planning
Section as early in the Public Review and Comment Period as possible, but no later than the last
day of this period. Requirements for petitions to change need determinations in the Proposed
North Carolina State Medical Facilities Plan are given below.
Instructions for Writing Petitions for Adjustments to Need Determinations
At a minimum, each written petition requesting an adjustment to a need determination in
the Proposed State Medical Facilities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. A statement of the requested adjustment, citing the provision or need
determination in the Proposed State Medical Facilities Plan for which the
adjustment is proposed.
3. Reasons for the proposed adjustment, including:
a. Statement of the adverse effects on the population of the
affected area that are likely to ensue if the adjustment is
not made, and
b. A statement of alternatives to the proposed adjustment
that were considered and found not feasible.
4. Evidence that health service development permitted by the proposed
adjustment would not result in unnecessary duplication of health
resources in the area.
5. Evidence that the requested adjustment is consistent with the three Basic
Principles governing the development of the N.C State Medical Facilities
Plan: Safety and Quality, Access and Value.
Petitioners should use the same service area definitions as provided in the program
chapters of the Proposed North Carolina State Medical Facilities Plan.
Petitioners should also be aware that the Medical Facilities Planning staff, in reviewing
the proposed adjustment, may request additional information and opinions from the petitioner or
any other person and organization(s) who may be affected by the proposed adjustment.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the Medical Facilities Planning Section by 5:00 p.m. on August 1, 2011.
Petitions must be submitted by e-mail, fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
701 Barbour Drive
Raleigh, North Carolina 27603
Response to Petitions for Adjustments to Need Determinations
The process for response to these petitions by the North Carolina Division of Health
Service Regulation and the North Carolina State Health Coordinating Council is as follows:
1. Preparation of an agency report. Staff may request additional information
from the petitioner.
2. Consideration of the petition and the agency report by the appropriate
committee of the North Carolina State Health Coordinating Council.
3. Committee submits its recommendations to the North Carolina State
Health Coordinating Council regarding disposition of the petition.
4. Consideration of the committee recommendations by the North
Carolina State Health Coordinating Council and decisions regarding
whether or not to incorporate the recommended adjustments in the final
North Carolina State Medical Facilities Plan to be forwarded to the
Governor.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for adjustments to need determinations in
the North Carolina State Medical Facilities Plan will be made no later than the date of the final
Council meeting of the calendar year.
Scheduled State Health Coordinating Council Meetings and Committee Meetings
Any changes to Council, Committee, Work Group and Public Hearing meeting dates, times and
locations will be posted on the meeting information web page at:
http://www.ncdhhs.gov/dhsr/mfp/meetings.html
North Carolina State Health Coordinating Council
March 2, 2011 The Jane S. McKimmon Ctr. 10:00 a.m.
(Wednesday) 1101 Gorman Street
Raleigh, NC 27695
May 25, 2011 To Be Determined 10:00 a.m.
(Wednesday)
September 28, 2011 To Be Determined 10:00 a.m.
(Wednesday)
http://mckimmon.ncsu.edu/mckimmon/directions.html
The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2012 State Medical Facilities Plan
immediately following the business meeting on March 2, 2011.
Acute Care Committee
April 13, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
May 4, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 14, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Long Term and Behavior Health Committee
May 6, 2011 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 16, 2011 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Technology and Equipment Committee
April 20, 2011 Dorothea Dix Campu 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
May 11, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 7, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
QAV Committee
April 6, 2011 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
September 15, 2011 Dorothea Dix Campus 10:00 a.m.
(Thursday) 801 Biggs Drive – Raleigh, NC
Brown Bldg. Room 104
Deadlines for Petitions and Comments, and Public Hearing Schedule
Any changes to Council, Committee and Public Hearing meeting dates, times and locations will
be posted on the meeting web page: http://www.ncdhhs.gov/dhsr/mfp/meetings.html.
The deadline for receipt by the Medical Facilities Planning Section (MFPS) of petitions, written
comments and written comments on petitions and comments is 5:00 p.m. on dates listed below.
March 2, 2011 The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2012 State Medical Facilities Plan
(SMFP) immediately following the business meeting.
March 2, 2011 Deadline for receipt of petitions for changes in basic policies and methodologies
and other written comments regarding the Proposed 2012 North Carolina State
Medical Facilities Plan
March 23, 2011 Deadline for receipt by the MFPS of written comments about Acute
Care Services related petitions and comments.
March 23, 2011 Deadline for receipt by the MFPS of written comments about Quality,
Access, and Value related petitions and comments.
March 30, 2011 Deadline for receipt by the MFPS of written comments about
Technology & Equipment related petitions and comments.
April 21, 2011 Deadline for receipt by the MFPS of written comments about Long-
Term and Behavioral Health related petitions and comments.
2011 Schedule for Public Hearings on the Proposed 2012 SMFP
(all hearings begin at 1:30 p.m.)
July 13, 2011 Greensboro Greensboro Area Health Education Center
July 15, 2011 Charlotte Carolinas College of Health Sciences
July 19, 2011 Greenville Pitt County Office Bldg.
July 26, 2011 Wilmington Coastal Area Health Education Center
July 29, 2011 Asheville Mountain Area Health Education Center
August 1, 2011 Raleigh Jane S. McKimmon Center
August 1, 2011 Deadline for receipt by MFPS of petitions for adjustments to need
determinations and other written comments regarding the Proposed
2012 SMFP.
August 17, 2011 Deadline for receipt by the MFPS of written comments about
Technology & Equipment related petitions and comments.
August 19, 2011 Deadline for receipt by the MFPS of written comments about Acute
Care Services related petitions and comments.
September 2, 2011 Deadline for receipt by the MFPS of written comments about Long
Term and Behavioral Health related petitions and comments.
September 2, 2011 Deadline for receipt by the MFPS of written comments about
Quality, Access and Value related petitions and comments.
Chapter 3:
Certificate of Need Review Categories and Schedule
CHAPTER 3
CERTIFICATE OF NEED REVIEW CATEGORIES AND SCHEDULE
Certificates of need are required prior to the development of new institutional health
services identified as needed in the North Carolina State Medical Facilities Plan. The Certificate
of Need Section shall determine the appropriate review category or categories in which an
application shall be submitted pursuant to 10A NCAC 14C .0202. For proposals which include
more than one category, an applicant must contact the Certificate of Need Section prior to
submittal of the application for a determination regarding the appropriate review category or
categories and the applicable review period in which the proposal must be submitted.
The categories are as follows:
Category A
Proposals submitted by acute care hospitals, except those proposals included in
Categories B through M.
Category B
Proposals to increase the number of nursing care or adult care home beds in a
county for which there is a need determination for additional beds; and proposals
for new continuing care retirement communities applying for exemption under
Policy NH-2 or Policy LTC-1.
Category C
Proposals for new psychiatric facilities; psychiatric beds in existing health care
facilities; new intermediate care facilities for the mentally retarded (ICF/MR) and
ICF/MR beds in existing health care facilities; new substance abuse and chemical
dependency treatment facilities and substance abuse and chemical dependency
treatment beds in existing health care facilities; and transfer of nursing care beds
from state psychiatric hospitals to local communities pursuant to Policy NH-5,
psychiatric beds from state psychatric hospitals to community facilities pursuant
to Policy PSY-1, and ICF/MR beds from state developmental centers to
community facilities pursuant to Chapter 858 of the 1983 Session Laws or Policy
ICF/MR-2.
Category D
Proposals for new dialysis stations in response to the “County Need” or “Facility
Need” methodologies; and relocation of existing certified dialysis stations to
another county.
Category E
Proposals for inpatient rehabilitation facilities; inpatient rehabilitation beds; and
licensed ambulatory surgical facilities, including single specialty ambulatory
surgery demonstration projects; new operating rooms and relocation of existing
operating rooms, as defined in G.S. 131E-176(18c), with the exception of the
relocation of an entire existing licensed ambulatory surgical facility within the
same county which is included in Category I.
Category F
Proposals for new Medicare-certified home health agencies or offices; new
hospices; new hospice inpatient facility beds; and new hospice residential care
facility beds.
Category G
Proposals for conversion of acute care beds to nursing care beds under Policy
NH-1; and proposals for the conversion of acute care beds to long-term care
hospital beds.
Category H
Proposals for bone marrow transplantation services, burn intensive care services,
neonatal intensive care services, open heart surgery services, solid organ
transplantation services, cardiac catheterization equipment, heart-lung bypass
machines, gamma knives, lithotriptors, fixed site magnetic resonance imaging
scanners, positron emission tomography scanners, linear accelerators, simulators,
major medical equipment as defined in G.S. 131E-176(14f), and diagnostic
centers as defined in G.S. 131E-176(7a).
Category I
Proposals for: cost overruns; expansions of existing continuing care retirement
communities which are licensed by the Department of Insurance at the date the
application is filed and are applying under Policy NH-2 or Policy LTC-1 for
exemption from need determinations in Chapter 10: Nursing Care Facilities or
Chapter 11: Adult Care Homes; relocation within the same county of an entire
existing health service facility (excluding acute care hospitals); relocation within
the same county of existing licensed nursing facility beds, existing licensed adult
care home beds, or existing certified dialysis stations; transfer of continuing care
retirement community beds pursuant to Policy NH-7; reallocation of beds or
services pursuant to Policy Gen-1; Category A or Policy AC-3 projects submitted
by Academic Medical Center Teaching Hospitals designated prior to January 1,
1990; acquisition of replacement equipment that does not result in an increase in
the inventory of the equipment; and, any other project not included in Categories
A through H or Categories J through M.
Category J
Proposals for: demonstration projects; statewide magnetic resonance imaging
scanner need determinations; and relocation of existing adult care home or
nursing facility beds, pursuant to Policy NH-4, NH-6 or LTC-2, to a different
county which does not have a need determination for additional beds; and any
new institutional health service, as defined in N.C.G.S. 131E-176(16), that is
proposed to be developed or offered in Gates, Graham, Hoke and Hyde counties,
with the exception of proposals in Category D or I.
Category K
Proposals for new or additional acute care beds in the acute care service area;
relocation of one or more existing licensed acute care beds to a different site
within the same acute care service area, except proposals included in Category J;
and new long-term care hospital beds.
Category L
Proposals for new mobile magnetic resonance imaging scanners.
Category M
Proposals for new or additional gastrointestinal endoscopy rooms as defined in
G.S. 131E-176(7d) and relocation of existing gastrointestinal endoscopy rooms as
set forth in G.S. 131E-176(16)u, with the excepton of the relocation of an entire
existing licensed ambulatory surgical facility within the same county which is
included in Category I.
Review Dates
Table 3A shows the review schedule, by category, for certificate of need applications
requiring review. However, a service, facility, or equipment for which a need determination is
identified in the North Carolina State Medical Facilities Plan will have only one scheduled
review date and one corresponding application filing deadline in the calendar year, even though
the table shows multiple review dates for the broad category. In order to determine the
designated filing deadline for a specific need determination in the North Carolina State Medical
Facilities Plan, an applicant must refer to the applicable need determination table for that service
in the related chapter in the Plan. Applications for certificates of need for new institutional health
services not specified in other chapters of the Plan shall be reviewed pursuant to the following
review schedule, with the exception that no reviews are scheduled if the need determination is
zero. Need determinations for additional dialysis stations pursuant to the “county need” or
“facility need” methodologies shall be reviewed in accordance with the provisions of Chapter 14.
In order to give the Certificate of Need Section sufficient time to provide public
notice of review and public notice of public hearings as required by G.S. 131E-185, the
deadline for filing certificate of need applications is 5:30 p.m. on the 15th day of the month
preceding the “CON Beginning Review Date.” In instances when the 15th day of the month
falls on a weekend or holiday, the filing deadline is 5:30 p.m. on the next business day. The
filing deadline is absolute and applications received after the deadline shall not be reviewed
in that review period. Applicants are strongly encouraged to complete all materials at least
one day prior to the filing deadline and to submit material early on the “Certificate of Need
Application Due Date.”
Table 3A: 2011 Certificate of Need Review Schedule
CON Beginning
Review Date
Health Service Area
I, II, III
Health Service Area
IV, V, VI
January 1, 2011 -- --
February 1, 2011 A, B, C, G, H, I --
March 1, 2011 -- A, B, C, E, G, H, I
April 1, 2011 C, D, E, F, H, I, K(1), M(1) D
May 1, 2011 C, E, F, H, I, K(4), M(4)
June 1, 2011 A, B, C, F, H, I
July 1, 2011 J A, B, C, E, H, I, J, K(5), M(5)
August 1, 2011 B, C, E, F, H, I, K(2), M(2) --
September 1, 2011 -- B, C, E, F, H, I
October 1, 2011 A, C, D, F, H, I D
November 1, 2011 B, C, E, H, I, L, K(3), M(3) --
December 1, 2011 -- A, B, C, E, F, H, I, L, K(6), M(6)
(1) HSA I only.
(2) HSA II only.
(3) HSA III only.
(4) HSA IV only.
(5) HSA V only.
(6) HSA VI only.
For further information about specific schedules, timetables, and certificate of need
application forms, contact:
North Carolina Division of Health Service Regulation
Certificate of Need Section
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
Phone: (919) 855-3873
Chapter 4:
Statement of Policies:
• Acute Care Hospitals
• Nursing Care Facilities
• Adult Care Homes
• Home Health Services
• End-Stage Renal Disease Dialysis Services
• Mental Health, Developmental Disabilities,
and Substance Abuse (General)
• Psychiatric Inpatient Services
• Intermediate Care Facilities for the Mentally Retarded
• All Health Services
CHAPTER 4
STATEMENT OF POLICIES
Summary of Policy Changes for 2011
Two substantive policy changes have been recommended for incorporation into the North
Carolina 2011 State Medical Facilities Plan. POLICY AC-5: REPLACEMENT OF ACUTE
CARE BED CAPACITY has been revised to include swing bed days when calculating Policy
AC-5 target occupancy rates for proposals to replace acute care beds in Critical Access
Hospitals.
POLICY GEN-4: ENERGY EFFICIENCY AND SUSTAINABLE BUILDING DESIGN
AND CONSTRUCTION is a preliminary energy policy developed in response to the Governor’s
directive to address more energy efficient and sustainable building design and construction for
certificate of need applicants proposing new or replacement health care facilities. Policy Gen-4
will continue to be expanded for future North Carolina State Medical Facility Plans.
Throughout Chapter 4, references to dates have been advanced by one year, as appropriate.
POLICIES APPLICABLE TO ACUTE CARE HOSPITALS (AC)
POLICY AC-1: USE OF LICENSED BED CAPACITY DATA FOR PLANNING
PURPOSES
For planning purposes the number of licensed beds shall be determined by the Division
of Health Service Regulation in accordance with standards found in 10A NCAC 13B - Section
.6200 and Section .3102 (d).
Licensed bed capacity of each hospital is used for planning purposes. It is the hospital's
responsibility to notify the Division of Health Service Regulation promptly when any of the
space allocated to its licensed bed capacity is converted to another use, including purposes not
directly related to health care.
POLICY AC-3: EXEMPTION FROM PLAN PROVISIONS FOR CERTAIN
ACADEMIC MEDICAL CENTER TEACHING HOSPITAL PROJECTS
Projects for which certificates of need are sought by academic medical center teaching
hospitals may qualify for exemption from the need determinations of this document. The
Medical Facilities Planning Section shall designate as an Academic Medical Center Teaching
Hospital any facility whose application for such designation demonstrates the following
characteristics of the hospital:
1. Serves as a primary teaching site for a school of medicine and at least one
other health professional school, providing undergraduate, graduate and
postgraduate education.
2. Houses extensive basic medical science and clinical research programs,
patients and equipment.
3. Serves the treatment needs of patients from a broad geographic area
through multiple medical specialties.
Exemption from the provisions of need determinations of the North Carolina State
Medical Facilities Plan shall be granted to projects submitted by Academic Medical Center
Teaching Hospitals designated prior to January 1, 1990 provided the projects comply with one of
the following conditions:
1. Necessary to complement a specified and approved expansion of the
number or types of students, residents or faculty, as certified by the head
of the relevant associated professional school; or
2. Necessary to accommodate patients, staff or equipment for a specified and
approved expansion of research activities, as certified by the head of the
entity sponsoring the research; or
3. Necessary to accommodate changes in requirements of specialty education
accrediting bodies, as evidenced by copies of documents issued by such
bodies.
A project submitted by an Academic Medical Center Teaching Hospital under this Policy
that meets one of the above conditions shall also demonstrate that the Academic Medical Center
Teaching Hospital’s teaching or research need for the proposed project cannot be achieved
effectively at any non-Academic Medical Center Teaching Hospital provider which currently
offers the service for which the exemption is requested and which is within 20 miles of the
Academic Medical Center Teaching Hospital.
Any health service facility or health service facility bed that results from a project
submitted under this Policy after January 1, 1999 shall be excluded from the inventory of that
health service facility or health service facility beds in the North Carolina State Medical
Facilities Plan.
POLICY AC-4: RECONVERSION TO ACUTE CARE
Facilities that have redistributed beds from acute care bed capacity to psychiatric,
rehabilitation, nursing care, or long-term care hospital use, shall obtain a certificate of need to
convert this capacity back to acute care. Applicants proposing to reconvert psychiatric,
rehabilitation, nursing care, or long-term care hospital beds back to acute care beds shall
demonstrate that the hospital’s average annual utilization of licensed acute care beds as
calculated using the most recent Thomson Reuters Days of Care as provided to the Medical
Facilities Planning Section by The Cecil G. Sheps Center for Health Services Research at the
University of North Carolina at Chapel Hill, is equal to or greater than the target occupancies
shown below, but shall not be evaluated against the acute care bed need determinations shown in
Chapter 5 of the North Carolina State Medical Facilities Plan. In determining utilization rates
and average daily census, only acute care bed “days of care” are counted.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-5: REPLACEMENT OF ACUTE CARE BED CAPACITY
Proposals for either partial or total replacement of acute care beds (i.e., construction of
new space for existing acute care beds) shall be evaluated against the utilization of the total
number of acute care beds in the applicant’s hospital in relation to utilization targets found
below. For hospitals not designated by the Center for Medicare and Medicaid Services as
Critical Access Hospitals, in determining utilization of acute care beds, only acute care bed
“days of care” shall be counted. For hospitals designated by the Center for Medicare and
Medicaid Services as Critical Access Hospitals, in determining utilization of acute care beds,
only acute care bed “days of care” and swing bed days (i.e., nursing facility days of care) shall
be counted in determining utilization of acute care beds. Any hospital proposing replacement of
acute care beds must clearly demonstrate the need for maintaining the acute care bed capacity
proposed within the application. Additionally, if the hospital is a Critical Access Hospital and
swing bed days are proposed to be counted in determining utilization of acute care beds, the
hospital shall also propose to remain a Critical Access Hospital and must demonstrate the need
for maintaining the swing bed capacity proposed within the application. If the Critical Access
Hospital does not propose to remain a Critical Access Hospital, only acute care bed “days of
care” shall be counted in determining utilization of acute care beds and the hospital must clearly
demonstrate the need for maintaining the acute care bed capacity proposed within the
application.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-6: HEART-LUNG BYPASS MACHINES FOR EMERGENCY COVERAGE
To protect cardiac surgery patients, who may require emergency procedures while
scheduled procedures are under way, a need is determined for one additional heart-lung bypass
machine whenever a hospital is operating an open heart surgery program with only one heart-lung
bypass machine. The additional machine is to be used to assure appropriate coverage for
emergencies and in no instance shall this machine be scheduled for use at the same time as the
machine used to support scheduled open heart surgery procedures. A certificate of need
application for a machine acquired in accordance with this provision shall be exempt from
compliance with the performance standards set forth in 10A NCAC 14C .1703(2).
POLICIES APPLICABLE TO NURSING CARE FACILITIES (NH)
POLICY NH-1: PROVISION OF HOSPITAL-BASED NURSING CARE
A certificate of need may be issued to a hospital which is licensed under G.S. 131E,
Article 5, and which meets the conditions set forth below and in 10A NCAC 14C .1100, to
convert up to 10 beds from its licensed acute care bed capacity for use as hospital-based nursing
care beds without regard to determinations of need in Chapter 10: Nursing Care Facilities, if the
hospital:
1. is located in a county which was designated as non-metropolitan by the
U.S. Office of Management and Budget on January 1, 2011; and
2. on January 1, 2011, had a licensed acute care bed capacity of 150 beds or
less.
The certificate of need shall remain in force as long as the North Carolina Department of
Health and Human Services determines that the hospital is meeting the conditions outlined in
this policy.
"Hospital-based nursing care" is defined as nursing care provided to a patient who has
been directly discharged from an acute care bed and cannot be immediately placed in a licensed
nursing facility because of the unavailability of a bed appropriate for the individual's needs.
Nursing care beds developed under this policy are intended to provide placement for
residents only when placement in other nursing care beds is unavailable in the geographic area.
Hospitals which develop nursing care beds under this policy shall discharge patients to other
nursing facilities with available beds in the geographic area as soon as possible where
appropriate and permissible under applicable law. Necessary documentation, including copies of
physician referral forms (FL 2) on all patients in hospital-based nursing units, shall be made
available for review upon request by duly authorized representatives of licensed nursing
facilities.
For purposes of this policy, beds in hospital-based nursing care shall be certified as a
"distinct part" as defined by the Centers for Medicare and Medicaid Services. Nursing care beds
in a "distinct part" shall be converted from the existing licensed acute care bed capacity of the
hospital and shall not be reconverted to any other category or type of bed without a certificate of
need.
An application for a certificate of need for reconverting beds to acute care shall be
evaluated against the hospital's service needs utilizing target occupancies shown in Policy AC-4,
without regard to the acute care bed need shown in Chapter 5: Acute Care Hospital Beds. A
certificate of need issued for a hospital-based nursing care unit shall remain in force as long as
the following conditions are met:
1. The nursing care beds shall be certified for participation in the Title XVIII
(Medicare) and Title XIX (Medicaid) programs;
2. The hospital discharges residents to other nursing facilities in the
geographic area with available beds when such discharge is appropriate
and permissible under applicable law;
3. Patients admitted shall have been acutely ill inpatients of an acute hospital
or its satellites immediately preceding placement in the nursing care unit.
The granting of beds for hospital-based nursing care shall not allow a hospital to convert
additional beds without first obtaining a certificate of need. Where any hospital, or the parent
corporation or entity of such hospital, any subsidiary corporation or entity of such hospital, or
any corporation or entity related to or affiliated with such hospital by common ownership,
control or management:
1. Applies for and receives a certificate of need for nursing care bed need
determinations in Chapter 10 of the North Carolina State Medical
Facilities Plan, or
2. Currently has nursing home beds licensed as a part of the hospital under
G.S. 131E, Article 5, or
3. Currently operates nursing care beds under the Federal Swing Bed
Program (P.L. 96-499),
Such hospital shall not be eligible to apply for a certificate of need for hospital-based
nursing care beds under this policy. Hospitals designated by the State of North Carolina as
Critical Access Hospitals pursuant to section 1820 (f) of the Social Security Act, as amended,
which have not been allocated nursing care beds under provisions of G.S. 131E 175-190, may
apply to develop beds under this policy. However, such hospitals shall not develop nursing care
beds both to meet needs determined in Chapter 10 of the North Carolina State Medical Facilities
Plan and this policy.
Beds certified as a "distinct part" under this policy shall be counted in the inventory of
existing nursing care beds and used in the calculation of unmet nursing care bed need for the
general population of a planning area.
Applications for certificates of need pursuant to this policy shall be accepted only for the
February 1 review cycle for Health Service Areas I, II and III, and for the March 1 review cycle
for Health Service Areas IV, V and VI. Nursing care beds awarded under this policy shall be
deducted from need determinations for the county as shown in Chapter 10: Nursing Care
Facilities.
Continuation of this policy shall be reviewed and approved by the North Carolina
Department of Health and Human Services annually. Certificates of need issued under policies
analogous to this policy in the North Carolina State Medical Facilities Plans subsequent to the
1986 Plan are automatically amended to conform with the provisions of this policy at the
effective date of this policy.
The North Carolina Department of Health and Human Services shall monitor this
program and ensure that patients affected by this policy are receiving services as indicated by
their care plan, and that conditions under which the certificate of need was granted are being
met.
POLICY NH-2: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for nursing care without regard to the nursing care bed need shown in
Chapter 10: Nursing Care Facilities. To qualify for such exemption, applications for certificates
of need shall show that the proposed nursing care bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of facilities for both of the following levels of care:
a. independent living accommodations (apartments and homes) for
people who are able to carry out normal activities of daily living
without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms;
b. licensed adult care home beds for use by people who, because of
age or disability require some personal services, incidental
medical services, and room and board to assure their safety and
comfort.
2. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing unit of the continuing care retirement community for a period
of at least 30 days. Exceptions shall be allowed when one spouse or
sibling is admitted to the nursing unit at the time the other spouse or
sibling moves into a non-nursing unit, or when the medical condition
requiring nursing care was not known to exist or be imminent when the
individual became a party to the continuing care contract.
3. Reflects the number of nursing care beds required to meet the current or
projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional nursing care.
4. Will not be certified for participation in the Medicaid program.
One half of the nursing care beds developed under this exemption shall be excluded from
the inventory used to project nursing care bed need for the general population. Certificates of
need issued under policies analogous to this policy in the North Carolina State Medical Facilities
Plans subsequent to the 1985 State Medical Facilities Plan are automatically amended to
conform with the provisions of this policy at the effective date of this policy. Certificates of
need awarded pursuant to the provisions of Chapter 920, Session Laws 1983 or Chapter 445,
Session Laws 1985 shall not be amended.
POLICY NH-3: DETERMINATION OF NEED FOR ADDITIONAL NURSING
CARE BEDS IN SINGLE PROVIDER COUNTIES
When a nursing care facility with fewer than 80 nursing care beds is the only nursing care
facility within a county, it may apply for a certificate of need for additional nursing care beds in
order to bring the minimum number of nursing care beds available within the county to no more
than 80 nursing care beds without regard to the nursing care bed need determination for that
county as listed in Chapter 10: Nursing Care Facilities.
POLICY NH-4: RELOCATION OF CERTAIN NURSING FACILITY BEDS
A certificate of need to relocate existing licensed nursing facility beds to another
county(ies) may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1, provided that the conditions set forth below and in 10A NCAC 14C .1100 and
the review criteria in G.S. 131E-183(a) are met. A facility applying for a certificate of need to
relocate nursing facility beds shall demonstrate that:
1. It is a non-profit nursing facility supported by and directly affiliated with a
particular religion and that it is the only nursing facility in North Carolina
supported by and affiliated with that religion;
2. The primary purpose for the nursing facility’s existence is to provide long-term
care to followers of the specified religion in an environment which
emphasizes religious customs, ceremonies, and practices;
3. Relocation of the nursing facility beds to one or more sites is necessary to
more effectively provide nursing care to followers of the specified religion
in an environment which emphasizes religious customs, ceremonies, and
practices;
4. The nursing facility is expected to serve followers of the specified religion
from a multi-county area; and
5. The needs of the population presently served shall be met adequately
pursuant to G.S. 131E-183.
Exemption from the need determinations in Chapter 10: Nursing Care Facilities shall be
granted to a nursing facility for purposes of relocating existing licensed nursing care beds to
another county provided that it complies with all of the criteria listed in Subparts 1 through 5
above.
Any certificate of need issued under this policy shall be subject to the following conditions:
1. The nursing facility shall relocate beds in at least two stages over a period
of at least six months or such shorter period of time as is necessary to
transfer residents desiring to transfer to the new facility and otherwise
make discharge arrangements acceptable to residents not desiring to
transfer to the new facility; and
2. The nursing facility shall provide a letter to the Licensure and
Certification Section, on or before the date that the first group of beds are
relocated, irrevocably committing the facility to relocate all of the nursing
facility beds for which it has a certificate of need to relocate; and
3. Subsequent to providing the letter to the Licensure and Certification
Section described in Subsection 2 above, the nursing facility shall accept
no new patients in the beds which are being relocated, except new patients
who, prior to admission, indicate their desire to transfer to the facility’s
new location(s).
POLICY NH-5: TRANSFER OF NURSING FACILITY BEDS FROM STATE
PSYCHIATRIC HOSPITAL NURSING FACILITIES TO COMMUNITY
FACILITIES
Beds in state psychiatric hospitals that are certified as nursing facility beds may be
relocated to licensed nursing facilities. However, before nursing facility beds are transferred out
of the state psychiatric hospitals, services shall be available in the community. State psychiatric
hospital nursing facility beds that are relocated to licensed nursing facilities shall be closed
within 90 days following the date the transferred beds become operational in the community.
Licensed nursing facilities proposing to operate transferred nursing facility beds shall
commit to serve the type of residents who are normally placed in nursing facility beds at the state
psychiatric hospitals. To help ensure that relocated nursing facility beds will serve those people
who would have been served by state psychiatric hospitals in nursing facility beds, a certificate
of need application to transfer nursing facility beds from a state hospital shall include a written
memorandum of agreement between the director of the applicable state psychiatric hospital; the
director of the North Carolina Division of State Operated Healthcare Facilities; the secretary of
the North Carolina Department of Health and Human Services; and the person submitting the
proposal.
This policy does not allow the development of new nursing care beds. Nursing care beds
transferred from state psychiatric hospitals to the community pursuant to Policy NH-5 shall be
excluded from the inventory.
POLICY NH-6: RELOCATION OF NURSING FACILITY BEDS
Relocations of existing licensed nursing facility beds are allowed only within the host
county and to contiguous counties currently served by the facility, except as provided in Policies
NH-4, NH-5 and NH-7. Certificate of need applicants proposing to relocate licensed nursing
facility beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed nursing facility beds in the county that would be losing nursing
facility beds as a result of the proposed project, as reflected in the North
Carolina State Medical Facilities Plan in effect at the time the certificate
of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed
nursing facility beds in the county that would gain nursing facility beds as
a result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICY NH-7: TRANSFER OF CONTINUING CARE RETIREMENT COMMUNITY
BEDS
A certificate of need to relocate existing licensed nursing beds to another county or
counties may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1 without regard to the nursing care bed need shown in Chapter 10, provided that
the following conditions are met:
1. Any certificate of need application filed pursuant to this policy must
satisfy:
a. the regulatory review criteria in 10A NCAC 14C.1100, except the
performance standards in 10A NCAC 14C.1102(a) and (b); and
b. the review criteria in G.S. 131E-183(a).
2. The nursing facility receiving the beds (“the receiving facility”) must:
a. be part of a not-for-profit continuing care retirement community
(CCRC);
b. be part of a CCRC which is affiliated through ownership,
governance, or leasehold with a not-for-profit organization which
provides long-term care to residents;
c. provide CCRC services to residents from multiple counties in
addition to the county in which the facility is located; and
d. use the transferred beds exclusively to meet the needs of people
either eligible for Medicaid or eligible for Medicaid within 45 days
of admission to the nursing facility bed with whom the facility has
continuing care contracts (in compliance with the North Carolina
Department of Insurance statutes and rules) who have lived in a non-nursing
unit of the continuing care retirement community for a period of at
least 30 days.
3. The nursing facility transferring the beds (“the transferring facility”) must
be a CCRC affiliated through ownership, governance or leasehold with the
same not-for-profit organization as the receiving facility.
4. The transferred beds shall not have been originally approved through the
certificate of need process on or after January 1, 1976 and shall have been
eligible prior to January 1, 1976 to be certified for Medicaid.
5. No more than five beds may be transferred to any single nursing facility
pursuant to this policy during any consecutive three-year period.
6. Certificate of need applicants proposing to relocate licensed nursing
facility beds under this policy shall demonstrate that the proposal will not
result in a deficit in the number of licensed nursing facility beds in the
county that would be losing nursing facility beds as a result of the
proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins.
7. Nursing facility beds relocated under this policy shall be counted in the
planning inventory of the receiving county.
POLICY NH-8: INNOVATIONS IN NURSING FACILITY DESIGN
Certificate of need applicants proposing new nursing facilities, replacement nursing
facilities, and projects associated with the expansion and/or renovation of existing nursing
facilities shall pursue innovative approaches in care practices, work place practices and
environmental design that address quality of care and quality of life needs of the residents.
These plans could include innovative design elements that encourage less institutional, more
home-like settings, privacy, autonomy and resident choice, among others.
POLICIES APPLICABLE TO ADULT CARE HOMES
POLICY LTC-1: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES – Adult Care Home Beds
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for adult care without regard to the adult care home bed need shown in
Chapter 11: Adult Care Homes. To qualify for such exemption, applications for certificates of
need shall show that the proposed adult care home bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of independent living accommodations (apartments and
homes) for people who are able to carry out normal activities of daily
living without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms.
2. Will provide for the provision of nursing services, medical services, or
other health related services as required for licensure by the North
Carolina Department of Insurance.
3. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing or adult care unit of the continuing care retirement
community for a period of at least 30 days. Exceptions shall be allowed
when one spouse or sibling is admitted to the adult care home unit at the
time the other spouse or sibling moves into a non-nursing or adult care
unit, or when the medical condition requiring nursing or adult care home
care was not known to exist or be imminent when the individual became a
party to the continuing care contract.
4. Reflects the number of adult care home beds required to meet the current
or projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional adult care home care.
5. Will not participate in the Medicaid program or serve State-County
Special Assistance recipients.
One half of the adult care home beds developed under this exemption shall be excluded
from the inventory used to project adult care home bed need for the general population.
Certificates of need issued under policies analogous to this policy in the North Carolina State
Medical Facilities Plans subsequent to the North Carolina 2002 State Medical Facilities Plan are
automatically amended to conform with the provisions of this policy at the effective date of this
policy.
POLICY LTC-2: RELOCATION OF ADULT CARE HOME BEDS
Relocations of existing licensed adult care home beds are allowed only within the host
county and to contiguous counties currently served by the facility. Certificate of need applicants
proposing to relocate licensed adult care home beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed adult care home beds in the county that would be losing adult
care home beds as a result of the proposed project, as reflected in the
North Carolina State Medical Facilities Plan in effect at the time the
certificate of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed adult
care home beds in the county that would gain adult care home beds as a
result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICIES APPLICABLE TO HOME HEALTH SERVICES (HH)
POLICY HH-3: NEED DETERMINATION FOR MEDICARE-CERTIFIED HOME
AGENCY IN A COUNTY
When a county has no Medicare-certified home health agency office physically located
within the county’s borders, and the county has a population of more than 20,000 people; or, if
the county has a population of less than 20,000 people and there is not an existing Medicare-certified
home health agency office located in a North Carolina county within 20 miles, need for
a new Medicare-certified home health agency office in the county is thereby established through
this policy. The “need determination” shall be reflected in the next annual North Carolina State
Medical Facilities Plan that is published following determination that a county meets the criteria
indicated above. (Population is based on population estimates/projections from the North
Carolina Office of State Budget and Management for the plan year in which the need
determination would be made excluding active duty military for any county with more than 500
active duty military personnel. The measurement of 20 miles will be in a straight line from the
closest point on the county line of the county in which an existing agency office is located to the
county seat of the county in which there is no agency.)
POLICIES RELATED TO END-STAGE RENAL DISEASE DIALYSIS SERVICES
(ESRD)
POLICY ESRD-2: RELOCATION OF DIALYSIS STATIONS
Relocations of existing dialysis stations are allowed only within the host county and to
contiguous counties currently served by the facility. Certificate of need applicants proposing to
relocate dialysis stations to contiguous counties shall:
1. demonstrate that the proposal shall not result in a deficit in the number of
Dialysis stations in the county that would be losing stations as a result of
the proposed project, as reflected in the most recent North Carolina
Semiannual Dialysis Report, and
2. demonstrate that the proposal shall not result in a surplus of dialysis
stations in the county that would gain stations as a result of the proposed
project, as reflected in the most recent North Carolina Semiannual
Dialysis Report.
GENERAL POLICY APPLICABLE TO ALL MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE FACILITIES (MH)
POLICY MH-1: LINKAGES BETWEEN TREATMENT SETTINGS
An applicant for a certificate of need for psychiatric, substance abuse, or Intermediate
Care Facilities for the Mentally Retarded beds shall document that the affected local
management entity has been contacted and invited to comment on the proposed services.
POLICIES APPLICABLE TO PSYCHIATRIC INPATIENT SERVICES FACILITIES
(PSY)
POLICY PSY-1: TRANSFER OF BEDS FROM STATE PSYCHIATRIC
HOSPITALS TO COMMUNITY FACILITIES
Beds in the state psychiatric hospitals used to serve short-term psychiatric patients may
be relocated to community facilities through the certificate of need process. However, before
beds are transferred out of the state psychiatric hospitals, services and programs shall be
available in the community. State psychiatric hospital beds that are relocated to community
facilities shall be closed within 90 days following the date the transferred beds become
operational in the community.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section of the North Carolina Department of Health and Human Services and
commit to serve the type of short-term patients normally placed at the state psychiatric hospitals.
To help ensure that relocated beds will serve those people who would have been served by the
state psychiatric hospitals, a proposal to transfer beds from a state hospital shall include a written
memorandum of agreement between the local management entity serving the county where the
beds are to be located, the secretary of the North Carolina Department of Health and Human
Services, and the person submitting the proposal.
POLICIES APPLICABLE TO INTERMEDIATE CARE FACILITIES FOR THE
MENTALLY RETARDED (ICF/MR)
POLICY ICF/MR-1: TRANSFER OF ICF/MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR MEDICALLY
FRAGILE CHILDREN
Intermediate Care Facilities for the Mentally Retarded (ICF/MR) beds in state operated
developmental centers may be relocated to community facilities through the certificate of need
process for the establishment of community ICF/MR facilities to serve children ages birth
through six years who have severe to profound developmental disabilities and are medically
fragile. This policy allows for the relocation or transfer of beds only and does not provide for
transfer of residents with the beds. State operated developmental center ICF/MR beds that are
relocated to community facilities shall be closed upon licensure of the transferred beds.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section demonstrating a commitment to serve children ages birth through six
years who have severe to profound developmental disabilities and are medically fragile. To help
ensure the relocated beds will serve these residents such proposal shall include a written
agreement with the following representatives: director of the local management entity serving
the county where the group home is to be located; the director of the applicable state operated
developmental center; the director of the North Carolina Division of State Operated Healthcare
Facilities; the secretary of the North Carolina Department of Health and Human Services and the
operator of the group home.
POLICY ICF/MR-2: TRANSFER OF ICF/MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR INDIVIDUALS
WHO CURRENTLY OCCUPY THE BEDS
Existing certified Intermediate Care Facilities for the Mentally Retarded (ICF/MR) beds
in state operated developmental centers may be transferred through the certificate of need
process to establish ICF/MR group homes in the community to serve people with complex
behavioral challenges and/or medical conditions for whom a community ICF/MR placement is
appropriate, as determined by the individual’s treatment team and with the individual/guardian
being in favor of the placement. This policy requires the transfer of the individuals who
currently occupy the ICF/MR beds in the developmental center to the community facility when
the beds are transferred. The beds in the state operated developmental center shall be closed
upon certification of the transferred ICF/MR beds in the community facility. Providers
proposing to develop transferred ICF/MR beds, as those beds are described in this policy, shall
submit an application to the Certificate of Need Section that demonstrates their clinical
experience in treating individuals with complex behavioral challenges or medical conditions in a
residential ICF/MR setting. To ensure the transferred beds will be used to serve these
individuals, a written agreement between the following parties shall be obtained prior to
development of the group home: director of the local management entity serving the county
where the group home is to be located, the director of the applicable developmental center, the
director of the North Carolina Division of State Operated Healthcare Facilities, the secretary of
the North Carolina Department of Health and Human Services and the operator of the group
home.
POLICIES APPLICABLE TO ALL HEALTH SERVICES (GEN)
The policy statements below apply to all health services including acute care (hospitals,
ambulatory surgical facilities, operating rooms, rehabilitation facilities, and technology); long-term
care (nursing homes, adult care homes, Medicare-certified home health agencies, end-stage
renal disease services and hospice services); mental health (psychiatric facilities, substance
abuse facilities, and ICF/MR) and services and equipment including bone marrow
transplantation services, burn intensive care services, neonatal intensive care services, open heart
surgery services, solid organ transplantation services, cardiac catheterization equipment, heart-lung
bypass machines, gamma knives, linear accelerators, lithotriptors, magnetic resonance
imaging scanners, positron emission tomography scanners, simulators, major medical equipment
as defined in G.S. 131E-176(14f), and diagnostic centers as defined in G.S. 131E-176(7a).
POLICY GEN-1: REALLOCATIONS
1. Reallocations shall be made only to the extent that the methodologies used
in this Plan to make need determinations indicate that need exists after the
inventories are revised and the need determinations are recalculated.
2. Beds or services which are reallocated once in accordance with this policy
shall not be reallocated again. Rather, the Medical Facilities Planning
Section shall make any necessary changes in the next annual North
Carolina State Medical Facilities Plan.
3. Dialysis stations that are withdrawn, relinquished, not applied for,
decertified, denied, appealed, or pending the expiration of the 30-day
appeal period shall not be reallocated. Instead, any necessary
redetermination of need shall be made in the next scheduled publication of
the North Carolina Semiannual Dialysis Report.
4. Appeals of Certificate of Need Decisions on Applications
Need determinations of beds or services for which the Certificate of Need
Section decision to approve or deny the application has been appealed
shall not be reallocated until the appeal is resolved.
a. Appeals resolved prior to August 17:
If such an appeal is resolved in the calendar year prior to August
17, the beds or services shall not be reallocated by the Certificate
of Need Section; rather the Medical Facilities Planning Section
shall make the necessary changes in the next annual North
Carolina State Medical Facilities Plan except for dialysis stations
which shall be processed pursuant to Item 3.
b. Appeals resolved on or after August 17:
If such an appeal is resolved on or after August 17 in the calendar
year, the beds or services, except for dialysis stations, shall be
made available for a review period to be determined by the
Certificate of Need Section, but beginning no earlier than 60 days
from the date that the appeal is resolved. Notice shall be mailed by
the Certificate of Need Section to all people on the mailing list for
the North Carolina State Medical Facilities Plan, no less than 45
days prior to the due date for receipt of new applications.
5. Withdrawals and Relinquishments
Except for dialysis stations, a need determination for which a certificate of
need is issued, but is subsequently withdrawn or relinquished, is available
for a review period to be determined by the Certificate of Need Section,
but beginning no earlier than 60 days from:
a. the last date on which an appeal of the notice of intent to withdraw
the certificate could be filed if no appeal is filed,
b. the date on which an appeal of the withdrawal is finally resolved
against the holder, or
c. the date that the Certificate of Need Section receives from the
holder of the certificate of need notice that the certificate has been
voluntarily relinquished.
Notice of the scheduled review period for the reallocated services or beds
shall be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no less
than 45 days prior to the due date for submittal of the new applications.
6. Need Determinations for which No Applications are Received
a. Services or beds with scheduled review in the calendar year on or
before September 1: The Certificate of Need Section shall not
reallocate the services or beds in this category for which no
applications were received, because the Medical Facilities
Planning Section will have sufficient time to make any necessary
changes in the determinations of need for these services or beds in
the next annual North Carolina State Medical Facilities Plan,
except for dialysis stations.
b. Services or beds with scheduled review in the calendar year after
September 1: Except for dialysis stations, a need determination in
this category for which no application has been received by the last
due date for submittal of applications shall be available to be
applied for in the second Category I review period in the next
calendar year for the applicable Health Service Area. Notice of the
scheduled review period for the reallocated beds or services shall
be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no
less than 45 days prior to the due date for submittal of new
applications.
7. Need Determinations not Awarded because Application Disapproved
a. Disapproval in the calendar year prior to August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section before August 17, shall not be reallocated by the
Certificate of Need Section. Instead the Medical Facilities
Planning Section shall make the necessary changes in the next
annual North Carolina State Medical Facilities Plan if no appeal is
filed, except for dialysis stations.
b. Disapproval in the calendar year on or after August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section on or after August 17, shall be reallocated by the
Certificate of Need Section, except for dialysis stations. A need in
this category shall be available for a review period to be
determined by the Certificate of Need Section but beginning no
earlier than 95 days from the date the application was disapproved,
if no appeal is filed. Notice of the scheduled review period for the
reallocation shall be mailed by the Certificate of Need Section to
all people on the mailing list for the North Carolina State Medical
Facilities Plan no less than 80 days prior to the due date for
submittal of the new applications.
8. Reallocation of Decertified Intermediate Care Facilities for the Mentally
Retarded (ICF/MR) Beds
If an ICF/MR facility’s Medicaid certification is relinquished or revoked,
the ICF/MR beds in the facility may be reallocated by the North Carolina
Department of Health and Human Services, Division of Health Service
Regulation, Medical Facilities Planning Section after consideration of
recommendations from the North Carolina Division of Mental Health,
Developmental Disabilities, and Substance Abuse Services. The North
Carolina Department of Health and Human Services, Division of Health
Service Regulation, Certificate of Need Section shall schedule reviews of
applications for any reallocated beds pursuant to Section (5) of this policy.
POLICY GEN-2: CHANGES IN NEED DETERMINATIONS
1. The need determinations adopted in this document or in the Dialysis
Reports shall be revised continuously throughout the calendar year to
reflect all changes in the inventories of:
a. the health services listed at G.S. 131E-176 (16)f;
b. health service facilities;
c. health service facility beds;
d. dialysis stations;
e. the equipment listed at G.S. 131E-176 (16)f1;
f. mobile medical equipment; and
g. operating rooms as defined in Chapter 6;
as those changes are reported to the Medical Facilities Planning Section.
However, need determinations in this document shall not be reduced if the
relevant inventory is adjusted upward 60 days or less prior to the
applicable “Certificate of Need Application Due Date.”
2. Inventories shall be updated to reflect:
a. decertification of Medicare-certified home health agencies or
offices, ICF/MR and dialysis stations;
b. delicensure of health service facilities and health service facility
beds;
c. demolition, destruction, or decommissioning of equipment as listed
at G.S. 131E-176(16)f1 and s;
d. elimination or reduction of a health service as listed at G.S. 131E-
176(16)f;
e. addition or reduction in operating rooms as defined in Chapter 6;
f. psychiatric beds licensed pursuant to G.S. 131E-184(c);
g. certificates of need awarded, relinquished, or withdrawn,
subsequent to the preparation of the inventories in the North
Carolina State Medical Facilities Plan;
h. corrections of errors in the inventory as reported to the Medical
Facilities Planning Section.
3. Any person who is interested in applying for a new institutional health
service for which a need determination is made in this document may
obtain information about updated inventories and need determinations
from the Medical Facilities Planning Section.
4. Need determinations resulting from changes in inventory shall be
available for a review period to be determined by the Certificate of Need
Section, but beginning no earlier than 60 days from the date of the action
identified in Subsection (2), except for dialysis stations which shall be
determined by the Medical Facilities Planning Section and published in
the next North Carolina Semiannual Dialysis Report. Notice of the
scheduled review period for the need determination shall be mailed by the
Certificate of Need Section to all people on the mailing list for the North
Carolina State Medical Facilities Plan no less than 45 days prior to the due
date for submittal of the new applications.
POLICY GEN-3: BASIC PRINCIPLES
A certificate of need applicant applying to develop or offer a new institutional health
service for which there is a need determination in the North Carolina State Medical Facilities
Plan shall demonstrate how the project will promote safety and quality in the delivery of health
care services while promoting equitable access and maximizing healthcare value for resources
expended. A certificate of need applicant shall document its plans for providing access to
services for patients with limited financial resources and demonstrate the availability of capacity
to provide these services. A certificate of need applicant shall also document how its projected
volumes incorporate these concepts in meeting the need identified in the State Medical Facilities
Plan as well as addressing the needs of all residents in the proposed service area.
POLICY GEN-4: ENERGY EFFICIENCY AND SUSTAINABILITY FOR HEALTH
SERVICE FACILITIES
Any person proposing a capital expenditure greater than $2 million to develop, replace,
renovate or add to a health service facility pursuant to G.S. 131E-178 shall include in its
certificate of need application a written statement describing the project’s plan to assure
improved energy efficiency and water conservation.
In approving a certificate of need proposing an expenditure greater than $5 million to
develop, replace, renovate or add to a health service facility pursuant to G.S. 131E-178, the
Certificate of Need Section shall impose a condition requiring the applicant to develop and
implement an Energy Efficiency and Sustainability Plan for the project that conforms to or
exceeds energy efficiency and water conservation standards incorporated in the latest editions of
the North Carolina State Building Codes. The plan must be consistent with the applicant’s
representation in the written statement as described in paragraph one of Policy GEN-4.
Any person awarded a certificate of need for a project or an exemption from review
pursuant to G.S. 131E-184 are required to submit a plan for energy efficiency and water
conservation that conforms to the rules, codes and standards implemented by the Construction
Section of the Division of Health Service Regulation. The plan must be consistent with the
applicant’s representation in the written statement as described in paragraph one of Policy GEN-
4. The plan shall not adversely affect patient or resident health, safety or infection control.
Chapter 5:
Acute Care Hospital Beds
CHAPTER 5
ACUTE CARE HOSPITAL BEDS
Summary of Bed Supply and Utilization
As of fall 2010, there are 114 licensed acute care hospitals and 20,647 licensed acute care
beds in North Carolina. Data provided by Thomson Reuters indicated that 4,452,438 days of care
were provided to patients in those hospitals during 2009, which represents an average annual
occupancy rate of 59.08 percent. These numbers exclude beds in service for substance abuse,
psychiatry, rehabilitation, hospice, and long-term care. In addition, across the state acute care
bed capacity is expected to increase in certain markets by 619 pending beds and to decrease in
other markets by 323 beds, for a net increase of 296 beds.
It is important to note that not all licensed beds were in service throughout the year.
Some beds were permanently idled, while others were temporarily taken out of service due to
staff shortages or to accommodate renovation projects.
Changes from the Previous Plan
Substantive changes to the Acute Care Bed Need Methodology have been incorporated
into the North Carolina 2011 State Medical Facilities Plan. The changes are summarized below:
1. The definition of Acute Care Bed Service Area was changed from the
definition shown below:
“The Acute Care Bed Service Area is a single county, except where there
is no hospital located within the county in which case the county or
counties without a hospital are combined in a multicounty grouping with a
county that has a hospital. Multicounty groupings are determined based
on the county in which the hospital or hospitals that provide the largest
number of inpatient days of care to the residents of the county which has
no hospital, except as described in the following sentences. In response to
a petition submitted to the State Health Coordinating Council, Hoke
County was assigned to Moore and Cumberland counties for the North
Carolina 2010 State Medical Facilities Plan. This created a Cumberland
Hoke Multicounty Acute Care Bed Service Area, in addition to the
existing Moore Hoke Multicounty Acute Care Bed Service Area. Data to
determine patient’s county of residence (based on the Thomson Reuters
data) that is used to establish the multicounty groupings were provided by
the Sheps Center. (Note: An acute care bed’s service area is the acute
care bed planning area in which the bed is located. The acute care bed
planning areas are the single and multicounty groupings shown in Figure
5.1.)” (North Carolina 2010 State Medical Facilities Plan, pages 44-45)
The revised Acute Care Bed Service Area definition is shown in
Application of the Methodology, Step 1.
2. Additionally, the Acute Care Bed Need Methodology assumptions used in
Table 5A were changed. The previous assumptions and the revised
assumptions are described in the table below:
Assumption Previous Revised
Data Source for Growth Rate Includes all days from N.C.
residents in N.C. acute care
hospitals.
Excludes all days from out-of-state
residents in N.C. acute care
hospitals.
Excludes days from psychiatric,
substance abuse and
rehabilitation hospitals.
Excludes outliers.
Includes acute care days only.
Excludes psychiatric, substance
abuse and rehabilitation days.
Includes outliers and non-N.C.
resident days.
Historical Patient Day Growth Uses four years of data and three
years of trend.
Uses five years of data and four
years of trend.
Number of Projection Years Six Four
Calculation Method for Growth
Rate Factors
Uses a statewide average growth
rate.
Uses a county-specific growth
rate without aggregating
counties with small hospitals.
Target Occupancy Rates
ADC 1-99
ADC 100-200
ADC>200 and <=400
ADC>400:
66.7%
71.4%
75.2%
75.2%
66.7%
71.4%
75.2%
78.0%
The revised Acute Care Bed Need assumptions from the above table were incorporated
into Table 5A of the North Carolina 2011 State Medical Facilities Plan.
The inventory has been updated and references to dates have been advanced by one year
as appropriate.
Basic Principles
A. Acute Care Hospital Goals
1. To facilitate continuing improvement in the state’s acute care
services. Advances in medical practice frequently entail the development
of new services, new facilities or both. The policy of the state is to
encourage their development when cost effective and essential to assure
reasonable accessibility to services.
2. To expand the availability of appropriate, adequate acute care service
to the people of North Carolina. Our improving highways and
transportation systems have brought acute care services within reasonable
geographic reach of all North Carolinians, but not within financial reach.
Despite the expansion of the state’s Medicaid Program, in 2004 17.5
percent of North Carolinians under the age of 65 were uninsured for a full
year, according to a study by the Cecil G. Sheps Center for Health
Services Research, at the University of North Carolina at Chapel Hill.
3. To protect the resource that the state’s acute care hospitals represent.
The acute care hospitals are the providers of essential health care services,
the state’s third largest employer, the largest single investment of public
funds in many communities, magnets for physicians deciding where to
practice, and building blocks in the economic development of their
communities. North Carolina must safeguard the future of its hospitals.
Even so, it is not the state’s policy to guarantee the survival and continued
operation of all the state’s hospitals, or even any one of them. In a
dynamic, fast-changing environment, which is moving away from
inpatient hospital services, the survival and future activities of hospitals
will be a function of many factors beyond the realm of state policy.
The state can, however, facilitate the survival of its hospitals and promote
the development of needed health care services, acute and non-acute, by
encouraging hospitals to convert unused acute care inpatient facilities to
new purposes, to collaborate with other health care providers, and to
develop health care delivery networks.
4. To encourage the substitution of less expensive for more expensive
services whenever feasible and appropriate. The state supports
continued and expanded use of programs which have demonstrated their
capacity to reduce both the number and length of hospital admissions,
including:
a. Development of health care delivery networks;
b. Increased use of ambulatory surgery;
c. Outpatient diagnostic studies;
d. Preadmission testing;
e. Preadmission certification;
f. Programs to reduce admission and readmission rates;
g. Timely scheduling of admissions;
h. Effective utilization review;
i. Discharge planning;
j. Appropriate use of alternative services such as home health
services, hospice, adult care homes, nursing homes; and
k. Initiating new, or maximizing existing, preventive health services.
5. To assure that substantial capital expenditures for the construction or
renovation of health care facilities are based on demonstrated need.
6. To assure that applicants proposing to expand or replace acute care
beds should provide careful analysis of what they have done to
promote cost-effective alternatives to inpatient care and to reduce
average length of stay.
B. Use of Swing Beds
The North Carolina Department of Health and Human Services supports the use of
"swing beds" in providing long-term nursing care services in rural acute care hospitals.
Section 1883 of the Social Security Act provides that certain small rural hospitals may
use their inpatient facilities to furnish skilled nursing facility (SNF) services to Medicare and
Medicaid beneficiaries and intermediate care facility (ICF) services to Medicaid beneficiaries.
Hospitals wishing to receive swing bed certification for Medicare patients must meet the
eligibility criteria outlined in the law which include:
1. Have a certificate of need, or a letter from the Certificate of Need Section
indicating that no certificate of need review is required to provide "swing
bed" services; and
2. Have a current valid Medicare provider agreement; and
3. Be located in an area of the state not designated as "urbanized" by the
most recent official census; and
4. Have fewer than 100 hospital beds, excluding beds for newborns and beds
in intensive type inpatient units; and
5. Not have in effect a 24-hour nursing waiver granted under 42 CFR
488.54(c); and
6. Not have had a swing bed approval terminated within the two years
previous to application; and
7. Meet the Swing Bed Conditions of Participation (see 42 CFR 482.66) on
Resident Rights; Admission, Transfer, and Discharge Rights; Resident
Behavior and Facility Practices; Patient Activities; Social Services;
Discharge Planning; Specialized Rehabilitative Services; and Dental
Services.
A certificate of need is not required if capital expenditures associated with the swing bed service
do not exceed $2 million, and there is no change in bed capacity.
Sources of Data
Inventory of Acute Care Beds:
The inventory of hospital facilities is maintained through the hospitals' response to a state
law that requires each facility to notify the North Carolina Department of Health and
Human Services and receive appropriate approvals before construction, alterations or
additions to existing buildings or any changes in bed capacities. Bed counts are revised
in the state's inventory as changes are reported and approved.
Days of Care and Patient Origin Data for the Bed Need Methodology:
The data source for annual days of care used in the methodology is Thomson Reuters, a
collector of hospital patient discharge information. The general acute care days of care
by facility and data on patients’ county of residence were provided by the Sheps Center
based on the Thomson Reuters data. (Note: The determination of whether a patient
record was categorized as an “acute care/general discharge” was determined by the
revenue code(s) for accommodation type, as submitted to Thomson Reuters by facilities
on the UB-92 form. Included in Column F, "Thomson 2009 Acute Care Days" are
records with revenue codes signifying an acute care/general accommodation type.
Likewise, any records that are coded as substance abuse, psychiatric, or rehabilitation
discharges are excluded from these figures.)
Basic Assumptions of the Methodology
 Target occupancies of hospitals should encourage efficiency of operation,
and vary with average daily census:
Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
ADC 1-99 66.7%
ADC 100-200 71.4%
ADC>200 and <=400 75.2%
ADC>400: 78.0%
 In determining utilization rates and average daily census, only acute care
bed “days of care” are counted.
 If a hospital has received approval to increase or decrease acute care bed
capacity, this change is incorporated into the anticipated bed capacity
regardless of the licensure status of the beds.
Application of the Methodology
Step 1
Counties that have at least one licensed acute care hospital are Single County Acute Care
Bed Service Areas unless the county is grouped with a county lacking a licensed acute care
hospital. When a county that has at least one licensed acute care hospital is grouped with a
county lacking a licensed acute care hospital, a Multicounty Acute Care Bed Service Area is
created.
All counties lacking a licensed acute care hospital are grouped with either one or two
counties that each have at least one licensed acute care hospital. A Multicounty Acute Care Bed
Service Area may consist of multiple counties lacking a licensed acute care hospital that are
grouped with either one or two counties that each have at least one licensed acute care hospital.
The three most recent years of available acute care days patient origin data are combined
and used to create the Multicounty Acute Care Bed Service Areas. These data are updated and
reviewed every three years. The Multicounty Acute Care Bed Service Areas are then updated, as
indicated by the data. The first update occurred in the North Carolina 2011 State Medical
Facilities Plan. The following decision rules are used to determine multicounty acute care bed
service area groupings.
1. Counties lacking a licensed acute care hospital are grouped with the single
county where the largest proportion of patients received inpatient acute
care services, as measured by acute inpatient days, unless;
a. Two counties with licensed acute care hospitals each provided
inpatient acute care services to at least 35 percent of the residents
who received inpatient acute care services, as measured by acute
inpatient days.
2. If 1 a. is true, then the county lacking a licensed acute care hospital is
grouped with both the counties which provided inpatient acute care
services to at least 35 percent of the residents who received inpatient acute
care services, as measured by acute inpatient days.
A county lacking a licensed acute care hospital becomes a Single County Acute Care Bed
Service Area upon licensure of an acute care hospital in that county. If a certificate of need is
issued for development of an acute care hospital in a county lacking an acute care hospital, the
acute care beds for which the certificate of need has been issued will be included in the inventory
of beds in that county’s multicounty acute care bed service area until those beds are licensed.
An acute care bed’s service area is the acute care bed planning area in which the bed is
located. The acute care bed planning areas are the single and multicounty groupings shown in
Figure 5.1.
Step 2 (Columns D and E)
Determine the number of acute care beds in the inventory by totaling:
(Column D)
a. the number of licensed acute care beds at each hospital;
(Column E)
b. the number of acute care beds for which certificates of need have been
issued, but for which changes in the license have not yet been made (i.e.,
additions, reductions, and relocations); and
c. the number of acute care beds for which a need determination in the North
Carolina State Medical Facilities Plan is pending review or appeal.
Step 3 (Column F)
Determine the total number of acute inpatient days of care provided by each hospital
based on the data contained in the above referenced report for Federal Fiscal Year 2009. (Please
see note in “Sources of Data” regarding identification of general acute days of care.)
Step 4 (Columns G and H)
Calculate the projected inpatient days of care in Federal Fiscal Year 2013 as follows:
a. For each county, determine the total annual number of acute inpatient days
of care provided in North Carolina acute care hospitals during each of the
last five federal fiscal years based on data provided by the Sheps Center.
b. For each county, calculate the difference in the number of acute inpatient
days of care provided from year to year.
c. For each county, for each of the last four years, determine the percentage
change from the previous year by dividing the calculated difference in
acute inpatient days by the total number of acute inpatient days provided
during the previous year. (Example: (YR 2009 – YR 2008) / YR 2009; etc.)
(Column G)
d. For each county, total the annual percentages of change and divide by four
to determine the average annual historical percentage change for each
county. For positive annual percentages of change, add 1 and this
becomes the County Growth Rate Multiplier. For negative annual
percentages of change, subtract 1. If the County Growth Rate Multiplier
is negative, Thomson Reuters 2009 Acute Care Days are carried forward
unchanged to Column H.
e. For each county with a positive County Growth Rate Multiplier, calculate
the compounded growth factor projected for the next four years by using
the average annual historical percentage change (from d. above) in the
first year and compounding the change each year thereafter at the same
rate.
(Column H)
f. For each hospital, multiply the acute inpatient days of care from Column F
by the compounded county growth factor to project the number of acute
inpatient days of care to be provided in Federal Fiscal Year 2013 at each
hospital.
Step 5 (Column I)
Calculate the projected midnight average daily census for each hospital in Federal Fiscal
Year 2013, by dividing the projected number of acute inpatient days of care provided at the
hospital (from Column H) by 365 days.
Step 6 (Column J)
Multiply each hospital's projected midnight average daily census from Step 5 (Column I)
by the appropriate target occupancy factor below:
Average Daily Census Occupancy Factor
Average Daily Census less than 100 1.50
Average Daily Census 100-200 1.40
Average Daily Census greater than 200 and <=400 1.33
Average Daily Census greater than 400 1.28
Step 7 (Column K)
Determine the surplus or deficit of beds for each hospital by subtracting the inventory of
beds in Step 2 (Column D plus Column E) from the number of beds generated in Step 6 (Column
J). (Note: Deficits will appear as positive numbers; surpluses, as negative numbers.)
Step 8 (Column L)
The number of acute care beds needed in a service area is determined as follows:
a. If two or more hospitals in the same service area are under common
ownership, total the surpluses and deficits of beds for those hospitals to
determine the surplus or deficit of beds for each owner of multiple
hospitals in the service area.
b. When the deficit of total acute care beds in the service area for an owner,
regardless of number of hospitals owned, equals or exceeds 20 beds or 10
percent of the inventory of acute care beds for that owner, the deficits of
all owners in the service area will be summed to determine the number of
acute care beds needed in the service area.
Qualified Applicants
Any qualified applicant may apply for a certificate of need to acquire the needed acute
care beds. A person is a qualified applicant if he or she proposes to operate the additional acute
care beds in a hospital that will provide:
1. a 24-hour emergency services department,
2. inpatient medical services to both surgical and non-surgical patients, and
3. if proposing a new licensed hospital, medical and surgical services on a daily
basis within at least five of the major diagnostic categories as recognized by the
Centers for Medicare and Medicaid Services (CMS), as follows:
MDC 1: Diseases and disorders of the nervous system
MDC 2: Diseases and disorders of the eye
MDC 3: Diseases and disorders of the ear, nose, mouth and throat
MDC 4: Diseases and disorders of the respiratory system
MDC 5: Diseases and disorders of the circulatory system
MDC 6: Diseases and disorders of the digestive system
MDC 7: Diseases and disorders of the hepatobiliary system and
pancreas
MDC 8: Diseases and disorders of the musculoskeletal system and
connective tissue
MDC 9: Diseases and disorders of the skin, subcutaneous tissue and
breast
MDC 10: Endocrine, nutritional and metabolic diseases and disorders
MDC 11: Diseases and disorders of the kidney and urinary tract
MDC 12: Diseases and disorders of the male reproductive system
MDC 13: Diseases and disorders of the female reproductive system
MDC 14: Pregnancy, childbirth and the puerperium
MDC 15: Newborns/other neonates with conditions originating in the
perinatal period
MDC 16: Diseases and disorders of the blood and blood-forming
organs and immunological disorders
MDC 17: Myeloproliferative diseases and disorders and poorly
differentiated neoplasms
MDC 18: Infectious and parasitic diseases
MDC 19: Mental diseases and disorders
MDC 20: Alcohol/drug use and alcohol/drug-induced organic mental
disorders
MDC 21: Injury, poisoning and toxic effects of drugs
MDC 22: Burns
MDC 23: Factors influencing health status and other contacts with
health services
MDC 24: Multiple significant trauma
MDC 25: Human immunodeficiency virus infections
CHEROKEE
SWAIN
JACKSON
GRAHAM
CHATHAM
POLK
BUNCOMBE
MADISON
ASHE
WATAUGA WILKES YADKIN
DAVIE
ROWAN
STOKES
FORSYTH
GUILFORD
ROCKINGHAM
CASWELL
RANDOLPH
DAVIDSON
COLUMBUS
ONSLOW
MOORE
HOKE
LEE
HARNETT
SCOTLAND
BLADEN
SAMPSON DUPLIN
WILSON
WAYNE
LENOIR
GREENE
CARTERET
UNION ANSON
CABARRUS
STANLY
RICHMOND
CRAVEN
JONES
PITT BEAUFORT
WASHINGTON
TYRRELL
DARE
MARTIN
EDGECOMBE
BERTIE
GATES NORTHAMPTON
HERTFORD
WARREN
FRANKLIN
WAKE
PERSON
VANCE
MCDOWELL BURKE
CALDWELL
MITCHELL
YANCEY
LINCOLN
GASTON
RUTHERFORD
CLEVELAND
MACON
CLAY
TRANSYLV ANIA
AVERY
CATAWBA
HYDE
BRUNSWICK
MONTGOMERY
ALEXANDER
ALLEGHANY
HENDERSON
CURRITUCK
PASQUOTANK
PERQUIM.
CAMDEN
CHOWAN
PAMLICO
NEW
HANOVER
SURRY
IREDELL
HAYWOOD
GRANVILLE
HALIFAX
NASH
JOHNSTON
DURHAM
ORANGE
ALAMANCE
CUMBERLAND
ROBESON
PENDER
MECKLENBURG
MOORE
HOKE
HOKE
CUMBERLAND
JACKSON
AHAM GR GRAHAM
BEAUFOR
HYDE
T
GATES
HERTFORD
PITT
HYDE
BUNCOMBE
GATES
PASQUOTANK
Figure 5.1: Acute Care Bed Service Areas
Shaded counties are multi-county acute care bed service areas, consisting of a county with one or more hospitals and a
nearby county or counties without an acute care hospital. County with Hospital
Hospital Multi-County Service Area Color Code
Duke University Hospital, Durham Regional Hospital, North Carolina Specialty Hospital Durham, Caswell
Murphy Medical Center Cherokee, Clay
Mission Hospitals Buncombe, Graham, Madison, Yancey
Harris Regional Hospital Jackson, Graham
First Health Moore Regional Moore, Hoke
Cape Fear Valley Medical Center Cumberland, Hoke
Maria Parham Hospital Vance, Warren
Our Community Hospital and Halifax Regional Medical Center Halifax, Northampton
Pitt County Memorial Hospital Pitt, Greene, Hyde
Craven Regional Medical Center Craven, Jones, Pamlico
Pungo District Hospital and Beaufort County Hospital Beaufort, Hyde
Roanoke-Chowan Hospital Hertford, Gates
Chowan Hospital Chowan, Tyrrell
Albemarle Hospital Pasquotank, Camden, Currituck, Gates, Perquimans
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
H0272
Alamance Regional Medical
Center Alamance 182 0 42,620 1.0027 43,088 118 165 -17 0
H0274 Alexander Hospital Alexander 25 0 0 0 0 0 -25 0
H0108 Alleghany Memorial Hospital Alleghany 41 0 2,316 -1.0816 2,316 6 10 -31 0
H0082 Anson Community Hospital Anson 52 0 4,088 -1.0966 4,088 11 17 -35 0
H0099 Ashe Memorial Hospital Ashe 76 0 4,814 -1.0256 4,814 13 20 -56 0
H0037
Charles A. Cannon, Jr.
Memorial Hospital Avery 30 0 6,101 -1.0816 6,101 17 25 -5 0
H0268 Bertie Memorial Hospital Bertie 6 0 1,674 1.0760 2,244 6 9 3 3
H0154
Cape Fear Valley - Bladen
County Hospital Bladen 48 0 3,082 -1.1060 3,082 8 13 -35 0
H0036 Mission Hospitals Buncombe 673 9 191,139 1.0287 214,024 586 751 69 69
2011 SMFP Buncombe
Madison Yancy Adjusted Need
Determination
Buncombe Madison
Yancey 51
H0031
Carolinas Medical Center -
NorthEast Cabarrus 447 0 101,362 1.0288 113,533 311 414 -33 0
H0061 Caldwell Memorial Hospital Caldwell 110 0 18,446 1.0520 22,591 62 93 -17 0
H0222 Carteret General Hospital Carteret 135 0 25,847 -1.0321 25,847 71 106 -29 0
H0007 Chatham Hospital Chatham 25 0 3,309 1.0772 4,455 12 18 -7 0
Note: Chatham Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
H0239 Murphy Medical Center Cherokee 57 0 9,615 1.0306 10,849 30 45 -12 0
H0063 Chowan Hospital Chowan 49 0 6,819 -1.0050 6,819 19 28 -21 0
H0045 Columbus County Hospital Columbus 154 0 22,091 -1.0406 22,091 61 91 -63 0
H0201 CarolinaEast Medical Canter Craven 307 0 68,398 -1.0300 68,398 187 262 -45 0
H0213
Cape Fear Valley Medical
Center Cumberland 490 41 150,096 1.0315 169,913 466 596 65 65
H0273 The Outer Banks Hospital Dare 21 0 3,162 3,162 9 13 -8 0
H0171 Davie County Hospital Davie 81 -31 831 -1.0243 831 2 3 -47 0
H0166 Duplin General Hospital Duplin 56 0 8,463 -1.0651 8,463 23 35 -21 0
H0258 Heritage Hospital Edgecombe 101 0 14,399 1.0228 15,759 43 65 -36 0
H0261
Franklin Regional Medical
Center Franklin 70 0 6,130 -1.1457 6,130 17 25 -45 0
Counties with one hospital shown first, followed by counties with more than one hospital.
In response to a petition, the need determination for the Buncombe Madison Yancy service area was adjusted to 51 from 69
acute care beds.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0105 Gaston Memorial Hospital Gaston 372 0 79,067 -1.0390 79,067 217 288 -84 0
H0098 Granville Medical Center Granville 62 0 7,963 1.0071 8,193 22 34 -28 0
H0025
Haywood Regional Medical
Center Haywood 153 0 17,623 -1.0249 17,623 48 72 -81 0
H0001 Roanoke-Chowan Hospital Hertford 86 0 14,058 -1.0503 14,058 39 58 -28 0
H0087 Harris Regional Hospital Jackson 86 0 14,987 -1.0354 14,987 41 62 -24 0
H0151 Johnston Memorial Hospital Johnston 157 22 34,709 -1.0120 34,709 95 143 -36 0
H0243 Central Carolina Hospital Lee 127 0 20,832 1.0178 22,352 61 92 -35 0
H0043 Lenoir Memorial Hospital Lenoir 218 0 42,389 -1.0289 42,389 116 163 -55 0
H0225
Carolinas Medical Center -
Lincoln Lincoln 101 0 15,881 1.0227 17,371 48 71 -30 0
H0078 Martin General Hospital Martin 49 0 8,115 1.0156 8,634 24 35 -14 0
H0097 The McDowell Hospital McDowell 65 0 5,745 -1.0903 5,745 16 24 -41 0
H0169 Blue Ridge Regional Hospital Mitchell 46 0 6,744 1.0038 6,847 19 28 -18 0
H0003
FirstHealth Montgomery
Memorial Hospital Montgomery 37 0 1,357 -1.1126 1,357 4 6 -31 0
H0100
FirstHealth Moore Regional
Hospital Moore 297 23 78,996 1.0124 82,977 227 302 -18 0
H0228 Nash General Hospital Nash 270 0 50,978 -1.0392 50,978 140 196 -74 0
H0221
New Hanover Regional Medical
Center New Hanover 647 0 148,223 -1.0117 148,223 406 520 -127 0
H0048 Onslow Memorial Hospital Onslow 162 0 30,250 -1.0053 30,250 83 124 -38 0
H0157
University of North Carolina
Hospitals Orange 678 51 188,516 1.0249 207,978 570 729 0 0
H0054 Albemarle Hospital Pasquotank 182 0 23,942 -1.0985 23,942 66 98 -84 0
H0115 Pender Memorial Hospital Pender 43 0 2,639 -1.1146 2,639 7 11 -32 0
H0066 Person Memorial Hospital Person 50 0 9,093 -1.0322 9,093 25 37 -13 0
H0104 Pitt County Memorial Hospital Pitt 734 0 204,768 1.0217 223,117 611 782 48 48
H0079 St. Luke's Hospital Polk 45 0 3,817 -1.0454 3,817 10 16 -29 0
H0013 Randolph Hospital Randolph 145 0 27,065 1.0343 30,979 85 127 -18 0
H0064
Southeastern Regional Medical
Center Robeson 292 0 57,851 -1.0399 57,851 158 222 -70 0
H0040
Rowan Regional Medical
Center Rowan 223 0 34,188 -1.0195 34,188 94 140 -83 0
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0039 Rutherford Hospital Rutherford 129 0 18,059 1.0007 18,110 50 74 -55 0
H0067
Sampson Regional Medical
Center Sampson 116 0 11,160 -1.0881 11,160 31 46 -70 0
H0107 Scotland Memorial Hospital Scotland 97 21 23,251 -1.0306 23,251 64 96 -22 0
H0008 Stanly Regional Medical Center Stanly 97 0 13,600 -1.0740 13,600 37 56 -41 0
H0165
Stokes-Reynolds Memorial
Hospital Stokes 53 0 732 -1.1784 732 2 3 -50 0
H0069 Swain County Hospital Swain 48 0 1,550 -1.0348 1,550 4 6 -42 0
H0111
Transylvania Community
Hospital Transylvania 42 0 5,646 -1.0098 5,646 15 23 -19 0
H0050
Carolinas Medical Center -
Union Union 157 0 39,847 1.0658 51,419 141 197 15 0
2010 SMFP Union County Adjusted Need Determination
2010 SMFP Union County
Adjusted Need Determination Union 25 0 1.0658 0 0
Union Total 157 25 0
H0267 Maria Parham Hospital Vance 91 0 18,367 -1.0270 18,367 50 75 -16 0
H0006 Washington County Hospital Washington 49 -37 1,855 -1.0801 1,855 5 8 -4 0
Note: Washington County Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
H0257 Wayne Memorial Hospital Wayne 255 0 58,855 -1.0056 58,855 161 226 -29 0
H0153 Wilkes Regional Medical Center Wilkes 120 0 15,339 -1.0789 15,339 42 63 -57 0
H0210 Wilson Medical Center Wilson 271 -73 33,422 -1.0079 33,422 92 137 -61 0
H0155
Yadkin Valley Community
Hospital (prev. Hoots Memorial
Hospital) Yadkin 22 0 792 -1.0224 792 2 3 -19 0
Note: Yadkin Valley Community Hospital 2009 acute care days have not been verified as correct - service area need determination not affected.
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0188 Beaufort County Hospital Beaufort 120 0 10,282 -1.0949 10,282 28 42 -78
H0002
Pungo District Hospital
Corporation Beaufort 39 0 1,955 -1.0949 1,955 5 8 -31
Beaufort Total 159 0 0
H0250 Brunswick Community Hospital Brunswick 60 14 11,305 -1.0133 11,305 31 46 -28
H0150
J. Arthur Dosher Memorial
Hospital Brunswick 36 0 4,363 -1.0133 4,363 12 18 -18
Brunswick Total 96 14 0
H0062 Grace Hospital Burke 162 0 20,473 -1.0310 20,473 56 84 -78
H0091 Valdese General Hospital Burke 131 0 10,436 -1.0310 10,436 29 43 -88
Burke Total 293 0 0
H0223 Catawba Valley Medical Center Catawba 200 0 36,473 -1.0173 36,473 100 150 -50
H0053 Frye Regional Medical Center Catawba 209 0 46,820 -1.0173 46,820 128 180 -29
Catawba Total 409 0 0
H0024
Cleveland Regional Medical
Center Cleveland 241 0 33,492 -1.0637 33,492 92 138 -103
H0113 Kings Mountain Hospital Cleveland 72 0 7,210 -1.0637 7,210 20 30 -42
Cleveland Total 313 0 0
H0027 Lexington Memorial Hospital Davidson 94 0 10,808 -1.0673 10,808 30 44 -50
H0112 Thomasville Medical Center Davidson 123 -10 10,452 -1.0673 10,452 29 43 -70
Davidson Total 217 -10 0
H0015 Duke University Hospital Durham 924 0 244,688 1.0116 256,260 702 899 -25
(Duke University Hospital has a CON for 14 additional acute care beds under Policy AC-3. These 14 beds are not counted when determining acute care bed need.)
H0233 Durham Regional Hospital Durham 316 0 64,634 1.0116 67,691 185 260 -56
1,240 0 309,322 323,950 888 1,158 -82
H0075
North Carolina Specialty
Hospital Durham 18 0 3,574 1.0116 3,743 10 15 -3
Durham Total 1,258 0 0
Duke/Durham Regional Hospital Totals
Projections based on 4 year average county specific Growth Rates compunded annually over the next four years.
Acute Care Days Data from 2005, 2006, 2007, 2008, 2009 used to generate 4 year growth rate.
(ADC=Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Revised Methodology
A B C D E F G H I J K L
License
Number Facility Name County
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Thomson
Reuters
2009 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years
Growth
Using County
Growth Rate
(=2009 Days, if
negative
growth)
2013 Projected
Average Daily
Census (ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit or
Surplus ("-" )
2013 Need
Determination
Counties with one hospital shown first, followed by counties with more than one hospital.
Target Occupancy Rates: ADC 1-99: 66.7% ADC 100-200: 71.4% ADC>200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50 ADC 100-200: 1.40 ADC>200 and <=400: 1.33 ADC>400: 1.28
2009 Utilization Data from Thomson Reuters compiled by the Cecil B. Sheps Center for Health Services Research.
H0209 Forsyth Medical Center Forsyth 784 49 209,634 1.0084 216,757 594 760 -73
H0229 Medical Park Hospital Forsyth 22 -10 3,713 1.0084 3,839 11 16 4
806 39 213,347 220,596 604 776 -69
H0011 North Carolina Baptist Hospitals Forsyth 802 0 205,527 1.0084 212,510 582 745 -57
Forsyth Total 1,608 39 0
H0052
High Point Regional He